Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA47248 | FL |
NPI | 1013039296 |
---|---|
Provider Name | Mr. Ricardo E Reillo |
First Address | Orlando, FL 32829 |
Second Address | Winter Park, FL 32789-7201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |