Healthcare Provider Details

I. General information

NPI: 1396658308
Provider Name (Legal Business Name): LUDMILA FONTAINE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 N ARMENIA AVE
TAMPA FL
33607-1001
US

IV. Provider business mailing address

2109 BAYSHORE BLVD UNIT 601
TAMPA FL
33606-3189
US

V. Phone/Fax

Practice location:
  • Phone: 813-873-2003
  • Fax:
Mailing address:
  • Phone: 813-317-0477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA51291
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: