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General NPI Number Information
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NPI Number | 1588126205
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Entity Type | Organization
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Legal Business Name | TIFFANY BALTIERO LMT LLC
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 2523 HERSCHEL ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4509
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Country | US
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Telephone | 904-405-8260
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Fax |
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Provider Business Mailing Address
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Address Line | 1286 MENNA ST
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City | JACKSONVILLE
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State | FL
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Zip | 32205-8330
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Country | US
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Telephone | 904-405-8260
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | TIFFANY BALTIERO
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Credential | LMT
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Telephone | 904-405-8260
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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 |
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License Number State |
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