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General NPI Number Information
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NPI Number | 1063789964
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Entity Type | Individual
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Provider Name | TIM HERLIHY LMT
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Gender | Male
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Dates
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Enumeration Date | 11/20/2011
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Last Update Date | 11/20/2011
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Provider Practice Location Address
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Address Line | 3016 3RD ST S UNIT 102
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-6011
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Country | US
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Telephone | 904-473-5913
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Fax |
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Provider Business Mailing Address
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Address Line | 27 ARBOR CLUB DR UNIT 216
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-2666
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Country | US
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Telephone | 904-473-5913
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA66119
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License Number State | FL
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