Healthcare Provider Details

I. General information

NPI: 1992016349
Provider Name (Legal Business Name): ELEANOR E CARACCI MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 NE JENSEN BEACH BLVD
JENSEN BEACH FL
34957-4706
US

IV. Provider business mailing address

1046 NE JENSEN BEACH BLVD
JENSEN BEACH FL
34957-4706
US

V. Phone/Fax

Practice location:
  • Phone: 772-334-0101
  • Fax:
Mailing address:
  • Phone: 772-334-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberMA 5958
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: