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General NPI Number Information
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NPI Number | 1811298490
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Entity Type | Organization
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Legal Business Name | MEDICAL MASSAGE SERVICES INC OF DAYTONA BEACH
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Dates
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Enumeration Date | 11/12/2010
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 345 CLYDE MORRIS BLVD 490
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City | ORMOND BEACH
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State | FL
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Zip | 32174-3111
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Country | US
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Telephone | 386-679-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 345 CLYDE MORRIS BLVD 490
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City | ORMOND BEACH
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State | FL
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Zip | 32174-3111
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Country | US
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Telephone | 386-679-7246
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY M CULLERS
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Credential | DC, LMT
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Telephone | 386-679-7246
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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 | MA18017
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License Number State | FL
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