Provider Demographics
NPI:1447354493
Name:REID, DEBORAH (LMT)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16701 NE 14TH AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2854
Mailing Address - Country:US
Mailing Address - Phone:305-944-9310
Mailing Address - Fax:925-835-4250
Practice Address - Street 1:2699 STIRLING ROAD
Practice Address - Street 2:SUITE A 105
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312
Practice Address - Country:US
Practice Address - Phone:954-865-8310
Practice Address - Fax:925-835-4250
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47343225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist