Individual provider · Type 1 NPI

Michael Ananta Rosidivito, LMT

Massage Therapist · Smyrna, GA

NPI number 1114661402 Active

Practice location

2200 Atlanta Rd SE Apt I3
Smyrna, GA 30080-1538

Call (609) 314-1254 Map

Specialties and licenses

TaxonomyCodeLicense
Massage Therapist Primary 225700000XMT011960 (GA)

Massage Therapist: An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.

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About NPI 1114661402

Michael Ananta Rosidivito, LMT's National Provider Identifier is 1114661402, issued on Apr 24, 2022. The primary taxonomy on file is Massage Therapist (225700000X), and the practice location is in Smyrna, GA. The record was last updated on Apr 24, 2022.