Provider Demographics
NPI:1609678135
Name:VERBITSKAYA, ELIZAVETA (LMT, MLD-C)
Entity type:Individual
Prefix:
First Name:ELIZAVETA
Middle Name:
Last Name:VERBITSKAYA
Suffix:
Gender:
Credentials:LMT, MLD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14797 PHILIPS HWY STE 206
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3746
Mailing Address - Country:US
Mailing Address - Phone:904-321-9065
Mailing Address - Fax:
Practice Address - Street 1:14797 PHILIPS HWY STE 206
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3746
Practice Address - Country:US
Practice Address - Phone:904-321-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA91263225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist