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General NPI Number Information
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NPI Number | 1417723826
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Entity Type | Individual
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Provider Name | MELODY ALLAINE JOHN
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Gender | Female
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 4400 N HIGHWAY 19A STE 12
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City | MOUNT DORA
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State | FL
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Zip | 32757-2022
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Country | US
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Telephone | 352-638-6765
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Fax |
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Provider Business Mailing Address
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Address Line | 124 SE 709TH ST
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City | OLD TOWN
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State | FL
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Zip | 32680-4027
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Country | US
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Telephone | 352-638-6765
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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 | MA46276
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License Number State | FL
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