Provider Demographics
NPI:1053565390
Name:LLERENA, JANET ANNETTE (LMT)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:ANNETTE
Last Name:LLERENA
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 1:8850 TERRENE CT
Mailing Address - Street 2:SUITES 102 &103
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-9525
Mailing Address - Country:US
Mailing Address - Phone:239-297-1885
Mailing Address - Fax:
Practice Address - Street 1:8850 TERRENE CT
Practice Address - Street 2:SUITES 102 &103
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-9525
Practice Address - Country:US
Practice Address - Phone:239-297-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA39451225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist