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General NPI Number Information
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NPI Number | 1790013654
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Entity Type | Organization
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Legal Business Name | MUSCLE EZE LLC
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 07/21/2011
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Provider Practice Location Address
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Address Line | 2620 MANATEE AVE W SUITE A
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City | BRADENTON
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State | FL
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Zip | 34205-4944
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Country | US
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Telephone | 941-981-0880
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Fax | 941-932-8094
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Provider Business Mailing Address
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Address Line | 2620 MANATEE AVE W SUITE A
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City | BRADENTON
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State | FL
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Zip | 34205-4944
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Country | US
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Telephone | 941-981-0880
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Fax | 941-932-8094
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Authorized Official
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Title or Position | MANAGER
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Name | MR. NEIL W HOLMES
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Credential | LMT
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Telephone | 941-981-0880
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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 | MM24923
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License Number State | FL
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