Healthcare Provider Details

I. General information

NPI: 1114007119
Provider Name (Legal Business Name): CONTEMPORARY PILATES & MASSAGE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 ENTERPRISE RD STE 101A
DEBARY FL
32713-2783
US

IV. Provider business mailing address

2845 ENTERPRISE RD STE 101A
DEBARY FL
32713-2783
US

V. Phone/Fax

Practice location:
  • Phone: 386-753-0868
  • Fax: 386-753-0870
Mailing address:
  • Phone: 386-753-0868
  • Fax: 386-753-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0002774
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA29772
License Number StateFL

VIII. Authorized Official

Name: JENNIFER A GIAGONELLI
Title or Position: OWNER / PRESIDENT
Credential:
Phone: 386-753-0868