Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 33112 | FL |
NPI | 1013110394 |
---|---|
Provider Name | Mr. Lemuel Felipe |
First Address | Tampa, FL 33614-2756 |
Second Address | Tampa, FL 33614-2800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 08/07/2007 |