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General NPI Number Information
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NPI Number | 1083808091
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Entity Type | Individual
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Provider Name | MARCY M BERTLING LMT
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Gender | Female
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Dates
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Enumeration Date | 09/03/2007
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Last Update Date | 09/03/2007
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Provider Practice Location Address
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Address Line | 101 DUGGAN AVE
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City | CRESTVIEW
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State | FL
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Zip | 32536-4812
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Country | US
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Telephone | 850-689-2260
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Fax |
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Provider Business Mailing Address
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Address Line | 5317 WHITNEY CT
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City | CRESTVIEW
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State | FL
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Zip | 32536-2212
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Country | US
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Telephone | 850-682-8051
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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 | 49778
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License Number State | FL
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