NPI 1619264157 · live from the CMS NPI Registry
Malissa M Bordelon, LMT
Massage Therapist in Long Beach, MS. National Provider Identifier 1619264157, active.
NPI record
| NPI | 1619264157 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Massage Therapist 225700000X |
| Practice location | 7198 Beatline Rd, Suite A, Long Beach, MS 39560 |
| Practice phone | 228-868-9799 |
| Mailing address | Po Box 8864, Gulfport, MS 39506 |
| Enumerated | July 5, 2011 |
| Last updated | July 5, 2011 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Massage Therapist primary | 225700000X | 1861 (MS) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.