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General NPI Number Information
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NPI Number | 1881990497
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Entity Type | Organization
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Legal Business Name | REGATTA POINT THERAPY & WELLNESS
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 1065 RIVERSIDE DR
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City | PALMETTO
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State | FL
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Zip | 34221-5008
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Country | US
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Telephone | 941-722-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 1065 RIVERSIDE DR
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City | PALMETTO
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State | FL
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Zip | 34221-5008
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Country | US
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Telephone | 941-722-2777
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PETER VANDERNOORD
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Credential |
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Telephone | 941-586-0808
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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 | MA4253
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License Number State | FL
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