Healthcare Provider Details

I. General information

NPI: 1356552715
Provider Name (Legal Business Name): KARIN WHITBECK L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADRID BLVD UNIT 411
PUNTA GORDA FL
33950-8929
US

IV. Provider business mailing address

100 MADRID BLVD UNIT 411
PUNTA GORDA FL
33950-8929
US

V. Phone/Fax

Practice location:
  • Phone: 941-833-3344
  • Fax: 941-833-0328
Mailing address:
  • Phone: 941-833-3344
  • Fax: 941-833-0328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 16850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: