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General NPI Number Information
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NPI Number | 1609152487
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Entity Type | Individual
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Provider Name | JEANIA MARIE INGLE L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 9750 SEMINOLE BLVD
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City | SEMINOLE
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State | FL
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Zip | 33772-2527
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Country | US
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Telephone | 727-481-7586
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Fax |
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Provider Business Mailing Address
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Address Line | 2931 S PINES DR APT 35
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City | LARGO
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State | FL
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Zip | 33771-3234
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Country | US
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Telephone | 727-481-7586
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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 | MA 48560
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License Number State | FL
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