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General NPI Number Information
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NPI Number | 1669647947
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Entity Type | Organization
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Legal Business Name | A HEALING ENERGY MASSAGE
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 8850 TERRENE CT SUITES 102 & 103
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-9525
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Country | US
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Telephone | 239-947-9392
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Fax | 239-947-9392
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Provider Business Mailing Address
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Address Line | 8850 TERRENE CT SUITES 102 & 103
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-9525
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Country | US
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Telephone | 239-947-9392
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Fax | 239-947-9392
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Authorized Official
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Title or Position | OWNER
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Name | MS. JANET ANNETTE LLERENA
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Credential | MASSAGE THERAPIST
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Telephone | 239-947-9392
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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 | MM21024
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License Number State | FL
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