Provider Demographics
NPI:1538746268
Name:LAROUSSINI, LINDA (LMBT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LAROUSSINI
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 NEW RIVER INLET RD UNIT 1205
Mailing Address - Street 2:
Mailing Address - City:N TOPSAIL BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28460-9560
Mailing Address - Country:US
Mailing Address - Phone:770-856-9875
Mailing Address - Fax:
Practice Address - Street 1:2000 NEW RIVER INLET RD UNIT 1205
Practice Address - Street 2:
Practice Address - City:N TOPSAIL BEACH
Practice Address - State:NC
Practice Address - Zip Code:28460-9560
Practice Address - Country:US
Practice Address - Phone:770-856-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-27
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14777225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14777OtherMASSAAGE THERAPY LICENSE