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General NPI Number Information
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NPI Number | 1780980722
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Entity Type | Organization
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Legal Business Name | AVALON MASSAGE & BODY WORKS INC.
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 05/05/2011
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Provider Practice Location Address
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Address Line | 430 SUMMERHAVEN DR 300
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City | DEBARY
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State | FL
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Zip | 32713-2755
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Country | US
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Telephone | 386-848-0548
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Fax |
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Provider Business Mailing Address
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Address Line | 430 SUMMERHAVEN DR 300
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City | DEBARY
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State | FL
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Zip | 32713-2755
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Country | US
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Telephone | 386-848-0548
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | TERESA MILLER
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Credential |
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Telephone | 386-848-0548
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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 | MM25438
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License Number State | FL
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