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General NPI Number Information
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NPI Number | 1134949373
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Entity Type | Individual
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Provider Name | ERMANE SAMUEL ALEXANDRE
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Gender | Male
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 408 E OCEAN AVE
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-4542
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Country | US
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Telephone | 561-318-0299
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Fax |
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Provider Business Mailing Address
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Address Line | 8140 AMBACH WAY
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City | HYPOLUXO
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State | FL
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Zip | 33462-6151
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Country | US
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Telephone | 561-318-0299
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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 | MA105571
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License Number State | FL
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