Healthcare Provider Details

I. General information

NPI: 1548602881
Provider Name (Legal Business Name): CLERMONT MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 S HIGHWAY 27 STE B
MINNEOLA FL
34715-2705
US

IV. Provider business mailing address

552 S HIGHWAY 27 STE B
MINNEOLA FL
34715-2705
US

V. Phone/Fax

Practice location:
  • Phone: 352-577-0600
  • Fax:
Mailing address:
  • Phone: 352-577-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3024
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMA60330
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License NumberMA60330
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60330
License Number StateFL

VIII. Authorized Official

Name: KRISTIN EVANS
Title or Position: OWNER
Credential: MT
Phone: 352-577-0600