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General NPI Number Information
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NPI Number | 1326689795
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Entity Type | Individual
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Provider Name | JESSE SPRAGUE LMT
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Gender | Male
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 2561 HARN BLVD UNIT 6
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City | CLEARWATER
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State | FL
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Zip | 33764-5133
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Country | US
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Telephone | 813-843-2374
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Fax |
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Provider Business Mailing Address
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Address Line | 5535 110TH AVE N # Q305
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City | PINELLAS PARK
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State | FL
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Zip | 33782-2258
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Country | US
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Telephone | 813-843-2374
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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 | MM88643
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License Number State | FL
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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 | MA88643
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License Number State | FL
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