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General NPI Number Information
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NPI Number | 1871221333
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Entity Type | Organization
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Legal Business Name | RESTORE & BALANCE
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Dates
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Enumeration Date | 08/12/2022
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 1901 9TH ST W STE B
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City | BRADENTON
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State | FL
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Zip | 34205-7029
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Country | US
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Telephone | 941-544-1638
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Fax |
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Provider Business Mailing Address
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Address Line | 4850 51ST ST W APT 7103
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City | BRADENTON
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State | FL
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Zip | 34210-6609
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Country | US
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Telephone | 941-544-1638
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER GEANNE WASHINGTON
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Credential | LMT
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Telephone | 941-544-1638
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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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