| Michael Ananta Rosidivito, LMT | |
|
2200 Atlanta Rd Se Apt I3, Smyrna, GA 30080-1538 | |
| (609) 314-1254 | |
| Not Available |
| Full Name | Michael Ananta Rosidivito |
|---|---|
| Gender | Male |
| Speciality | Massage Therapist |
| Location | 2200 Atlanta Rd Se Apt I3, Smyrna, Georgia |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114661402 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225700000X | Massage Therapist | MT011960 (Georgia) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Michael Ananta Rosidivito, LMT 2200 Atlanta Rd Se Apt I3, Smyrna, GA 30080-1538 Ph: (160) 931-4125 | Michael Ananta Rosidivito, LMT 2200 Atlanta Rd Se Apt I3, Smyrna, GA 30080-1538 Ph: (609) 314-1254 |
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