Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA9129 | FL |
NPI | 1023026218 |
---|---|
Provider Name | Mr. Frank Pierrepont Whitridge JR. |
First Address | Fort Pierce, FL 34949-2901 |
Second Address | Fort Pierce, FL 34949-2901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |