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General NPI Number Information
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NPI Number | 1699271700
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Entity Type | Organization
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Legal Business Name | FLORIDA DANCER'S GALLERY
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 12323 SW 55TH ST STE 1010
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City | COOPER CITY
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State | FL
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Zip | 33330-3312
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Country | US
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Telephone | 954-437-9910
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Fax |
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Provider Business Mailing Address
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Address Line | 12323 SW 55TH ST STE 1010
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City | COOPER CITY
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State | FL
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Zip | 33330-3312
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Country | US
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Telephone | 954-437-9910
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHRISTIE STARK
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Credential |
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Telephone | 954-882-8762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number |
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License Number State | FL
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