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General NPI Number Information
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NPI Number | 1760795777
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Entity Type | Organization
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Legal Business Name | ROGER GRECO L.M.T. LLC
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 06/17/2011
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Provider Practice Location Address
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Address Line | 1011 VIRGINIA DR SUITE 102
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City | ORLANDO
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State | FL
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Zip | 32803-2531
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Country | US
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Telephone | 407-712-5280
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Fax |
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Provider Business Mailing Address
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Address Line | 3218 ANDERSON PL
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City | ORLANDO
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State | FL
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Zip | 32803-6744
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Country | US
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Telephone | 407-712-5280
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Fax |
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Authorized Official
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Title or Position | OPERATING MANAGER AND SECRETARY
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Name | ROGER GRECO
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Credential | L.M.T.
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Telephone | 407-712-5280
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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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