Healthcare Provider Details

I. General information

NPI: 1710393772
Provider Name (Legal Business Name): KARI BUBNOW LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NW 16TH AVE
GAINESVILLE FL
32601-4202
US

IV. Provider business mailing address

501 NW 16TH AVE
GAINESVILLE FL
32601-4202
US

V. Phone/Fax

Practice location:
  • Phone: 352-537-9516
  • Fax:
Mailing address:
  • Phone: 352-537-9516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA74057
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: