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General NPI Number Information
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NPI Number | 1659825529
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Entity Type | Organization
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Legal Business Name | LA PAZ SALON
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 9020 58TH DR E
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City | BRADENTON
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State | FL
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Zip | 34202-6107
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Country | US
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Telephone | 610-212-8865
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Fax |
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Provider Business Mailing Address
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Address Line | 10927 KIRKWALL PORT DR
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City | WIMAUMA
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State | FL
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Zip | 33598-6146
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Country | US
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Telephone | 610-212-8865
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. KIEL UNGER
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Credential | LMT
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Telephone | 610-212-8865
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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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