Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA57802 | FL |
N | 226300000X | Kinesiotherapist | MA57802 | FL |
NPI | 1093034050 |
---|---|
Provider Name | Mr. Achut Mashruwala |
First Address | Tampa, FL 33614-6152 |
Second Address | Tampa, FL 33614-6152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2010 |
Last Update Date | 28/05/2010 |