Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA59841 | FL |
NPI | 1003315516 |
---|---|
Provider Name | Carl James Rutledge |
First Address | St Petersburg, FL 33710-7413 |
Second Address | St Petersburg, FL 33710-7413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2018 |
Last Update Date | 10/02/2018 |