NPI 1114661402

Michael Ananta Rosidivito, LMT

Practitioner Massage Therapist Smyrna, GA

Practice location

Address: 2200 Atlanta Rd SE APT I3, Smyrna, GA 30080-1538
Phone: (609) 314-1254

Registered specialties

Massage Therapist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225700000X Licence MT011960 (GA)

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Registry record

NPI: 1114661402
Entity type: Individual
Sex (as registered): Male
NPI issued: 24 Apr 2022
Record last updated: 24 Apr 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.