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PAULA BLACK LMT
>> Massage Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1386829455
Individual Registrant: PAULA BLACK LMT
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
2430 S BAY ST EUSTIS, FL 32726-6363 US
Tel: 352-217-5913 Fax: 800-878-6689
Tel: 352-217-5913 Fax: 800-878-6689
Contact information for business:
37110 SHALIMAR DR FRUITLAND PARK, FL 34731-5693 US
Tel: 352-217-5913 Fax: 800-878-6689
Tel: 352-217-5913 Fax: 800-878-6689
Registration Information:
NPI: 1386829455
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Massage Therapist | FL | MA41889 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| BCBS | C2910 | FL | 01 |
