Healthcare Provider Details

I. General information

NPI: 1477870483
Provider Name (Legal Business Name): SIMONE M ARCHBALD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7036 ORTEGA AVE
SPRING HILL FL
34609-1053
US

IV. Provider business mailing address

7036 ORTEGA AVE
SPRING HILL FL
34609-1053
US

V. Phone/Fax

Practice location:
  • Phone: 813-880-7577
  • Fax: 813-880-7553
Mailing address:
  • Phone: 813-880-7577
  • Fax: 813-880-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA58554
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: