Healthcare Provider Details

I. General information

NPI: 1295063535
Provider Name (Legal Business Name): WEST ORANGE MASSAGE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 WINTER GARDEN VINELAND RD STE 124
WINTER GARDEN FL
34787-6370
US

IV. Provider business mailing address

1218 WINTER GARDEN VINELAND RD STE 124
WINTER GARDEN FL
34787-6370
US

V. Phone/Fax

Practice location:
  • Phone: 407-965-1892
  • Fax:
Mailing address:
  • Phone: 407-965-1892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMM23884
License Number StateFL

VIII. Authorized Official

Name: EMILY E TORNATORE
Title or Position: CO-OWNER
Credential: LMT
Phone: 407-965-1892