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General NPI Number Information
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NPI Number | 1578815239
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Entity Type | Individual
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Provider Name | MS. XUEQING WANG DITTRICH
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Gender | Female
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 10/06/2012
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Provider Practice Location Address
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Address Line | 2831 RINGLING BLVD STE 113D
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City | SARASOTA
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State | FL
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Zip | 34237-5363
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Country | US
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Telephone | 941-363-7968
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Fax |
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Provider Business Mailing Address
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Address Line | 2610 COCONUT BAY LN UNIT 2C
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City | SARASOTA
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State | FL
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Zip | 34237-3056
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Country | US
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Telephone | 941-914-4801
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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 | MA70075
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License Number State | FL
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