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General NPI Number Information
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NPI Number | 1609697580
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Entity Type | Organization
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Legal Business Name | PRIVILEGED FACES, LLC
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 701 W DR MARTIN LUTHER KING JR BLVD STE 6
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City | TAMPA
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State | FL
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Zip | 33603-3100
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Country | US
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Telephone | 813-693-2328
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Fax |
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Provider Business Mailing Address
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Address Line | 701 W DR MARTIN LUTHER KING JR BLVD STE 6
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City | TAMPA
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State | FL
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Zip | 33603-3100
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Country | US
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Telephone | 813-693-2328
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY BLACKMON
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Credential |
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Telephone | 334-714-3249
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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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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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