Healthcare Provider Details

I. General information

NPI: 1366720161
Provider Name (Legal Business Name): SALLY DONNA PLINK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SALLY DONNA PLINK LMT

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10671 104TH AVE N
SEMINOLE FL
33773
US

IV. Provider business mailing address

10671 104TH AVE N
SEMINOLE FL
33773
US

V. Phone/Fax

Practice location:
  • Phone: 727-459-4575
  • Fax: 727-286-6974
Mailing address:
  • Phone: 727-459-4575
  • Fax: 727-286-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number56820
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: