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General NPI Number Information
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NPI Number | 1538499553
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Entity Type | Individual
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Provider Name | JAMES JOSEPH PASSIATORE LMT
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Gender | Male
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 112 N.W. MADISON CT
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-3584
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Country | US
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Telephone | 772-343-8963
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Fax |
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Provider Business Mailing Address
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Address Line | 112 N.W. MADISON COURT
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-3584
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Country | US
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Telephone | 772-343-8963
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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 | MA57052
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License Number State | FL
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