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General NPI Number Information
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NPI Number | 1144015231
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Entity Type | Individual
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Provider Name | PETR MARCAN
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Gender | Male
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 6405 INITIATIVE BLVD # 113
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City | SARASOTA
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State | FL
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Zip | 34240-1249
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Country | US
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Telephone | 941-376-2343
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Fax |
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Provider Business Mailing Address
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Address Line | 8783 LANCELOT AVE
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City | NORTH PORT
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State | FL
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Zip | 34287-3756
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Country | US
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Telephone |
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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 | 54031
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA54031
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License Number State | FL
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