Healthcare Provider Details

I. General information

NPI: 1780759035
Provider Name (Legal Business Name): MARY B ZUKOWSKI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 NW 12TH AVE SUITE C3
GAINESVILLE FL
32601
US

IV. Provider business mailing address

PO BOX 84
EARLETON FL
32631
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-8002
  • Fax:
Mailing address:
  • Phone: 352-373-8002
  • Fax: 352-373-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA8883
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: