Healthcare Provider Details

I. General information

NPI: 1285647503
Provider Name (Legal Business Name): LAUREL J FREEMAN LAUREL FREEMAN, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2622 NW 43RD ST STE C1
GAINESVILLE FL
32606-6679
US

IV. Provider business mailing address

2622 NW 43RD STREET STE C1
GAINESVILLE FL
32606-6679
US

V. Phone/Fax

Practice location:
  • Phone: 352-371-9689
  • Fax: 352-378-7558
Mailing address:
  • Phone: 352-371-9689
  • Fax: 352-378-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA7670/MM3449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: