Healthcare Provider Details

I. General information

NPI: 1770652315
Provider Name (Legal Business Name): PATRICIA A. DOUGLAS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 SNOW ST SUITE 17
OXFORD AL
36203-1987
US

IV. Provider business mailing address

1225 SNOW ST SUITE 17
OXFORD AL
36203-1987
US

V. Phone/Fax

Practice location:
  • Phone: 256-832-3112
  • Fax:
Mailing address:
  • Phone: 256-832-3112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1727
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: