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General NPI Number Information
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NPI Number | 1356764302
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE HOLISTIC REHAB CLINIC
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Dates
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Enumeration Date | 01/28/2014
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Last Update Date | 01/28/2014
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Provider Practice Location Address
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Address Line | 2040 COLLIER AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-8124
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Country | US
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Telephone | 954-628-2478
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Fax |
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Provider Business Mailing Address
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Address Line | 2040 COLLIER AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-8124
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Country | US
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Telephone | 954-628-2478
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | JEAN R EUGENE
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Credential | LMT
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Telephone | 954-628-2478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MM31700
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License Number State | FL
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