Healthcare Provider Details

I. General information

NPI: 1538993845
Provider Name (Legal Business Name): JASON VIGLIOTTI LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 NW 76TH DR
GAINESVILLE FL
32607-1593
US

IV. Provider business mailing address

330 NW 76TH DR
GAINESVILLE FL
32607-1593
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-7400
  • Fax:
Mailing address:
  • Phone: 352-332-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number83466
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: