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General NPI Number Information
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NPI Number | 1538238985
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Entity Type | Individual
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Provider Name | JAMIE HANUKA LMT
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 01/16/2012
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Provider Practice Location Address
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Address Line | 2648 CENTENNIAL PL
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City | TALLAHASSEE
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State | FL
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Zip | 32308-0572
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Country | US
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Telephone | 850-402-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 CASTLETOWER RD
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City | TALLAHASSEE
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State | FL
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Zip | 32301
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Country | US
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Telephone | 850-402-0200
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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 | MA39724
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License Number State | FL
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