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General NPI Number Information
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NPI Number | 1194989186
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Entity Type | Organization
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Legal Business Name | 20 WEST
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 20 W WENTWORTH ST
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City | ENGLEWOOD
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State | FL
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Zip | 34223-2949
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Country | US
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Telephone | 941-475-0020
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Fax | 941-475-9131
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Provider Business Mailing Address
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Address Line | 20 W WENTWORTH ST
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City | ENGLEWOOD
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State | FL
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Zip | 34223-2949
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Country | US
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Telephone | 941-475-0020
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Fax | 941-475-9131
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Authorized Official
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Title or Position | OWNER
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Name | CLAUDIA ANNETTE DAVENPORT
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Credential |
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Telephone | 941-475-0020
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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 | MM21062
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License Number State | FL
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