=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174709596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING HANDS OF WELLNESS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2008
-----------------------------------------------------
Last Update Date | 09/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13574 VILLAGE PARK DR #145
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-791-9905
-----------------------------------------------------
Fax | 407-386-6520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3956 TOWN CENTER BLVD #520
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-791-9905
-----------------------------------------------------
Fax | 407-386-6520
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JEAN-PAUL ROSS
-----------------------------------------------------
Credential | MA23185
-----------------------------------------------------
Telephone | 407-791-9905
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA23185
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------