Healthcare Provider Details

I. General information

NPI: 1083625487
Provider Name (Legal Business Name): EDWIN D HOOPER II LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3904 MAVERICK AVE
SARASOTA FL
34233-1543
US

IV. Provider business mailing address

3904 MAVERICK AVE
SARASOTA FL
34233-1543
US

V. Phone/Fax

Practice location:
  • Phone: 941-379-0301
  • Fax: 941-379-0301
Mailing address:
  • Phone: 941-379-0301
  • Fax: 941-379-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 14439
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: