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General NPI Number Information
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NPI Number | 1639316441
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Entity Type | Individual
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Provider Name | RUZA VACEK RICHARDSON LMT, BA
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Gender | Female
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Dates
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Enumeration Date | 01/15/2009
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Last Update Date | 01/15/2009
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Provider Practice Location Address
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Address Line | 3801 PARK ST N SUITE #2
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City | SAINT PETERSBURG
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State | FL
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Zip | 33709-4078
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Country | US
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Telephone | 727-343-8783
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Fax |
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Provider Business Mailing Address
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Address Line | 3908 58TH AVE N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33714-1131
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Country | US
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Telephone | 727-515-9475
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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 | 13778
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License Number State | FL
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