Healthcare Provider Details

I. General information

NPI: 1922332576
Provider Name (Legal Business Name): BETTE CAROL HEGARTY LICENSED MASSAGE THE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8146 THAMES BLVD. UNIT C
BOCA RATON FL
33433-8524
US

IV. Provider business mailing address

8146-C THAMES BLVD. UNIT-C.
BOCA RATON FL
33433-8524
US

V. Phone/Fax

Practice location:
  • Phone: 561-654-5194
  • Fax: 561-921-1644
Mailing address:
  • Phone: 561-654-5194
  • Fax: 561-921-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA0020100
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: