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General NPI Number Information
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NPI Number | 1902074578
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Entity Type | Organization
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Legal Business Name | SGI MASSAGE LLC
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 6150 METROWEST BLVD SUITE 301
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City | ORLANDO
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State | FL
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Zip | 32835
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Country | US
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Telephone | 407-595-7461
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Fax |
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Provider Business Mailing Address
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Address Line | 9376 MUSTARD LEAF DR
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City | ORLANDO
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State | FL
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Zip | 32827
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Country | US
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Telephone | 407-595-7461
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. YUKIKO TUBAUDO
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Credential | LMT
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Telephone | 407-595-7461
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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 | MA38404
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License Number State | FL
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