Healthcare Provider Details

I. General information

NPI: 1578372678
Provider Name (Legal Business Name): MORGAN GUDE LMT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 NW 6TH ST STE C1
GAINESVILLE FL
32609-8535
US

IV. Provider business mailing address

1810 NW 6TH ST STE C1
GAINESVILLE FL
32609-8535
US

V. Phone/Fax

Practice location:
  • Phone: 386-209-5290
  • Fax:
Mailing address:
  • Phone: 386-209-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number105932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: