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General NPI Number Information
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NPI Number | 1699032680
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Entity Type | Organization
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Legal Business Name | BLUE ZONE WELLNESS CENTER
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Dates
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Enumeration Date | 04/16/2012
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Last Update Date | 04/16/2012
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Provider Practice Location Address
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Address Line | 1488 S PALM AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-5520
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Country | US
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Telephone | 954-367-9015
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Fax |
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Provider Business Mailing Address
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Address Line | 1488 S PALM AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-5520
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Country | US
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Telephone | 954-367-9015
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IRICA DORE
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Credential |
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Telephone | 954-213-5903
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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 | MA50141
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License Number State | FL
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