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General NPI Number Information
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NPI Number | 1891441820
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Entity Type | Individual
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Provider Name | KENNA VICTORIA COLLEY LMT
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Gender | Female
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 375 N STATE ROAD 434 STE 2001-204
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-2132
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Country | US
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Telephone | 772-453-7338
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Fax |
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Provider Business Mailing Address
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Address Line | 1190 POST LAKE PL APT 304
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City | APOPKA
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State | FL
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Zip | 32703-2919
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Country | US
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Telephone | 772-453-7338
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MA95808
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License Number State | FL
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