Provider Demographics
NPI:1316122195
Name:EVANGELISTI, MARIE V (LMT)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:V
Last Name:EVANGELISTI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2400 WINDING CREEK BLVD
Mailing Address - Street 2:BLDG10-102
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4326
Mailing Address - Country:US
Mailing Address - Phone:727-791-8166
Mailing Address - Fax:727-723-3160
Practice Address - Street 1:132 10TH AVE N
Practice Address - Street 2:105
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3407
Practice Address - Country:US
Practice Address - Phone:727-712-3925
Practice Address - Fax:727-723-3160
Is Sole Proprietor?:No
Enumeration Date:2007-12-30
Last Update Date:2007-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLMA0021344225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist