Healthcare Provider Details

I. General information

NPI: 1518209824
Provider Name (Legal Business Name): CHERYL LYNN PUTNAM LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4168 WOODLANDS PKWY SUITE B
PALM HARBOR FL
34685-3496
US

IV. Provider business mailing address

1715 MARINER WAY
TARPON SPRINGS FL
34689-5852
US

V. Phone/Fax

Practice location:
  • Phone: 727-785-2545
  • Fax: 727-781-0617
Mailing address:
  • Phone: 727-940-3697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA66050
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: