Healthcare Provider Details

I. General information

NPI: 1356794309
Provider Name (Legal Business Name): JANE DACUNHA MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 PARK CENTRAL CT 2
NAPLES FL
34109-6003
US

IV. Provider business mailing address

809 PALM VIEW DR
NAPLES FL
34110-1241
US

V. Phone/Fax

Practice location:
  • Phone: 239-777-6024
  • Fax: 239-734-3068
Mailing address:
  • Phone: 239-777-6024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number73980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: