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General NPI Number Information
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NPI Number | 1518265909
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Entity Type | Organization
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Legal Business Name | SEASIDE MASSAGE THERAPY CENTER, INC.
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Dates
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Enumeration Date | 03/09/2011
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 4615 GULF BLVD SUITE 113
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City | ST PETE BEACH
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State | FL
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Zip | 33706-2462
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Country | US
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Telephone | 727-363-8333
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Fax | 727-360-5026
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Provider Business Mailing Address
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Address Line | 4615 GULF BLVD SUITE 113
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City | ST PETE BEACH
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State | FL
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Zip | 33706-2462
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Country | US
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Telephone | 727-363-8333
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Fax | 727-360-5026
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUDITH KAY LEPPANEN
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Credential | LMT
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Telephone | 727-363-8333
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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 | MM12050
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License Number State | FL
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