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General NPI Number Information
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NPI Number | 1982699807
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Entity Type | Organization
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Legal Business Name | CHARLOTTE WORKERS COMP INJURY CENTER INC
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 324 CROSS ST
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City | PUNTA GORDA
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State | FL
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Zip | 33950-4802
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Country | US
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Telephone | 941-575-8228
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Fax | 941-575-9743
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Provider Business Mailing Address
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Address Line | PO BOX 495665
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City | PORT CHARLOTTE
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State | FL
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Zip | 33949-5665
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Country | US
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Telephone | 941-575-8228
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Fax | 941-575-9743
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DEBORAH L AMARAL
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Credential |
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Telephone | 941-575-8228
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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 | MM8900
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MM8388
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License Number State | FL
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