Healthcare Provider Details

I. General information

NPI: 1922945617
Provider Name (Legal Business Name): MICHAEL ROBERT WITHEE LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 NEWBERRY RD STE 4
GAINESVILLE FL
32607-2822
US

IV. Provider business mailing address

202A NE LUCKY AVE
MICANOPY FL
32667-4117
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-6565
  • Fax:
Mailing address:
  • Phone: 352-262-5857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA57088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: