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General NPI Number Information
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NPI Number | 1992171037
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Entity Type | Organization
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Legal Business Name | RADIANCE HEALTH AND BEAUTY
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 1850 W FAIRBANKS AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-4559
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Country | US
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Telephone | 407-758-7874
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Fax |
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Provider Business Mailing Address
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Address Line | 936 S LAKE STERLING CT
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City | CASSELBERRY
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State | FL
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Zip | 32707-5400
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Country | US
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Telephone | 407-758-7874
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Fax |
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Authorized Official
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Title or Position | FULL SPECIALIST/LMT
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Name | ROCIO I LORA
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Credential | FS/LMT
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Telephone | 407-758-7874
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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 | MA60398
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | FS878771
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License Number State | FL
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