Healthcare Provider Details

I. General information

NPI: 1184963647
Provider Name (Legal Business Name): RENEE ESCOBAR L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 S TAMIAMI TRL
VENICE FL
34293-5004
US

IV. Provider business mailing address

PO BOX 1175
NOKOMIS FL
34274-1175
US

V. Phone/Fax

Practice location:
  • Phone: 253-686-9708
  • Fax:
Mailing address:
  • Phone: 253-686-9608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00012315
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA87242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: