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General NPI Number Information
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NPI Number | 1346567450
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC MASSAGE OF SOUTHWEST FLORIDA, INC.
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Dates
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Enumeration Date | 04/28/2010
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 6700 WINKLER RD SUITE 1
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City | FORT MYERS
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State | FL
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Zip | 33919-7233
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Country | US
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Telephone | 239-994-6558
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Fax | 239-481-0022
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Provider Business Mailing Address
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Address Line | 3315 SW 12TH AVE
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City | CAPE CORAL
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State | FL
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Zip | 33914-5112
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Country | US
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Telephone | 239-994-6558
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Fax | 239-481-0022
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Authorized Official
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Title or Position | PRESIDENT-OWNER
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Name | MR. GARY R GLIDDEN
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Credential | L.M.T.
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Telephone | 239-994-6558
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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 | MA58593
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License Number State | FL
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