Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | LMT 34031 | FL |
NPI | 1003046459 |
---|---|
Provider Name | Mr. Eugene Duane Butterfield |
First Address | Lakeland, FL 33801-6319 |
Second Address | Lakeland, FL 33801-6319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2009 |
Last Update Date | 20/07/2009 |