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General NPI Number Information
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NPI Number | 1689790057
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Entity Type | Individual
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Provider Name | JEAN PATRICK FLORESTAL L M T
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1000 EXECUTIVE DR
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City | OVIEDO
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State | FL
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Zip | 32765-8140
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Country | US
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Telephone | 407-971-6830
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Fax |
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Provider Business Mailing Address
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Address Line | 5855 MARBLE CT
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City | WINTER PARK
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State | FL
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Zip | 32792-9398
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Country | US
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Telephone | 407-696-6962
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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 | MA27106
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License Number State | FL
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