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General NPI Number Information
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NPI Number | 1295365526
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Entity Type | Individual
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Provider Name | JUAN CARLOS FLEITAS MA 67136
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Gender | Male
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Dates
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Enumeration Date | 01/26/2020
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Last Update Date | 01/26/2020
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Provider Practice Location Address
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Address Line | 1900 MAIN ST STE 108
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City | SARASOTA
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State | FL
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Zip | 34236-5950
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Country | US
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Telephone | 941-592-4393
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Fax |
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Provider Business Mailing Address
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Address Line | 1660 55TH AVENUE CIR E APT 203
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City | BRADENTON
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State | FL
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Zip | 34203-4483
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Country | US
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Telephone | 941-592-4393
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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 |
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License Number State |
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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 | MA67136
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License Number State | FL
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