Healthcare Provider Details

I. General information

NPI: 1962366641
Provider Name (Legal Business Name): CHANCEE DELISA TERRY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7894 BUFFALO RIDGE RD
PACE FL
32571-5234
US

IV. Provider business mailing address

7894 BUFFALO RIDGE RD
PACE FL
32571-5234
US

V. Phone/Fax

Practice location:
  • Phone: 205-344-3443
  • Fax: 205-344-3443
Mailing address:
  • Phone: 205-344-3443
  • Fax: 205-344-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA96616
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: