Provider Demographics
NPI:1558626382
Name:LEKANIDES, DENISE ROSE (LMT)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ROSE
Last Name:LEKANIDES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 651487
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32965
Mailing Address - Country:US
Mailing Address - Phone:772-913-1362
Mailing Address - Fax:
Practice Address - Street 1:1255 37TH ST.
Practice Address - Street 2:SUITE D
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-562-2400
Practice Address - Fax:772-569-3208
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA19702225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist