Provider Demographics
NPI:1427616150
Name:PIERCE, CLARISSA (LMT, RT(T))
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LMT, RT(T)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4688 CORAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2252
Mailing Address - Country:US
Mailing Address - Phone:754-214-0802
Mailing Address - Fax:
Practice Address - Street 1:10139 NW 31ST ST STE 101
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3908
Practice Address - Country:US
Practice Address - Phone:954-755-1292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-57930172M00000X, 225700000X
FLCRT-919142085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology