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General NPI Number Information
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NPI Number | 1225324114
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Entity Type | Organization
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Legal Business Name | RECONCILED THERAPY
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 742 VENICE CIR APT 104
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City | LAKE PARK
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State | FL
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Zip | 33403-1872
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Country | US
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Telephone | 561-846-0275
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Fax |
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Provider Business Mailing Address
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Address Line | 742 VENICE CIR APT 104
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City | LAKE PARK
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State | FL
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Zip | 33403-1872
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Country | US
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Telephone | 561-846-0275
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | WILLETTE VICTORIA MORALES
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Credential | LMT
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Telephone | 561-846-0275
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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 | MA56364
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License Number State | FL
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