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General NPI Number Information
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NPI Number | 1952126393
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Entity Type | Organization
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Legal Business Name | THE D1V1N3 LLC
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 8406 N 16TH ST APT A
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City | TAMPA
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State | FL
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Zip | 33604-1980
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Country | US
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Telephone | 407-638-1004
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Fax |
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Provider Business Mailing Address
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Address Line | 8406 N 16TH ST APT A
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City | TAMPA
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State | FL
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Zip | 33604-1980
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Country | US
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Telephone | 407-638-1004
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | LALINI ASHMEADE
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Credential |
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Telephone | 407-638-1004
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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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