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General NPI Number Information
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NPI Number | 1306197322
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Entity Type | Individual
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Provider Name | MRS. KATHRYN LIANNE CHURCHILL
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Gender | Female
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 791 NE 5TH ST
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4325
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Country | US
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Telephone | 352-364-4133
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Fax |
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Provider Business Mailing Address
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Address Line | 5252 S ATWOOD TER
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City | INVERNESS
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State | FL
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Zip | 34452-8108
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Country | US
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Telephone | 813-760-0925
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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 | MA62884
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License Number State | FL
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