Healthcare Provider Details

I. General information

NPI: 1205958451
Provider Name (Legal Business Name): THOMAS HUTTEMAN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 MEDICAL LN
FORT MYERS FL
33907-1116
US

IV. Provider business mailing address

7164 KOLA TER APT 32
FORT MYERS FL
33907-7712
US

V. Phone/Fax

Practice location:
  • Phone: 239-839-8801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA43520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: