Healthcare Provider Details

I. General information

NPI: 1386110914
Provider Name (Legal Business Name): BETH HELENE HUREWITZ BCTMB, ORD, LMT, LE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 6TH ST
SAINT AUGUSTINE FL
32080-7910
US

IV. Provider business mailing address

213 6TH ST
SAINT AUGUSTINE FL
32080-7910
US

V. Phone/Fax

Practice location:
  • Phone: 904-461-9962
  • Fax:
Mailing address:
  • Phone: 904-461-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA77793
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: