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NPI Code Detail

MEDICARE: STEEM FITNESS & MASSAGE LLC

MEDICARE: STEEM FITNESS & MASSAGE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MA 78630OTHERFLNPI #1104209410

General Provider Information

NPI Number : 1528443017
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEEM FITNESS & MASSAGE LLC
Provider Business Mailing Address
First Line : 16951 SW 63RD MNR
Second Line :
City : SOUTHWEST RANCHES
State : FL
Zip : 33331-1773
Country : US
Telephone Number : 954-471-7950
Fax Number :
Provider Business Practice Location Address
First Line : 4621 N UNIVERSITY DR
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33067-4602
Country : US
Telephone Number : 954-471-7950
Fax Number :
Authorized Official
Title or Position : SOLE MBR
Name : DESMOND DEPASS
Credential : L.M.T.
Telephone Number : 954-471-7950
Provider Enumeration Date : 07/25/2015
Last Update Date : 07/25/2015

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Directions to “STEEM FITNESS & MASSAGE LLC ” Practice Location

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