Healthcare Provider Details

I. General information

NPI: 1003025750
Provider Name (Legal Business Name): FAUNIA JO LOOMIS FOX LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 NEWBERRY ROAD
GAINESVILLE FL
32609
US

IV. Provider business mailing address

917 NE 9TH AVE
GAINESVILLE FL
32601
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-2116
  • Fax: 352-373-1507
Mailing address:
  • Phone: 352-219-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: