Provider Demographics
NPI:1740171628
Name:LIBESSART, DIDIER ANDRE
Entity type:Individual
Prefix:
First Name:DIDIER
Middle Name:ANDRE
Last Name:LIBESSART
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 BIRD RD STE 502
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1515
Mailing Address - Country:US
Mailing Address - Phone:305-663-4499
Mailing Address - Fax:
Practice Address - Street 1:3850 BIRD RD STE 502
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1515
Practice Address - Country:US
Practice Address - Phone:305-663-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA67830225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist