Healthcare Provider Details

I. General information

NPI: 1912385337
Provider Name (Legal Business Name): ROBERT MONAHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2732 CAPITAL CIR NE SUITE 3
TALLAHASSEE FL
32308-4108
US

IV. Provider business mailing address

1564 WILLIAMS LANDING RD
TALLAHASSEE FL
32310-2469
US

V. Phone/Fax

Practice location:
  • Phone: 850-508-1934
  • Fax:
Mailing address:
  • Phone: 580-508-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: