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General NPI Number Information
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NPI Number | 1265799605
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Entity Type | Organization
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Legal Business Name | PAIN SOLUTIONS THERAPEUTIC & SPORTS MASSAGE
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 04/23/2012
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Provider Practice Location Address
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Address Line | 25355 W NEWBERRY RD SUITE 2
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City | NEWBERRY
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State | FL
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Zip | 32669-4253
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Country | US
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Telephone | 352-226-2976
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 983
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City | NEWBERRY
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State | FL
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Zip | 32669-0983
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Country | US
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Telephone | 352-226-2976
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETER/ MASSAGE THERAPIST
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Name | PATRICIA FAYE NYBERG
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Credential | LMT
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Telephone | 352-226-2976
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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 | MA46707
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License Number State | FL
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