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WANDA LYNN BLAKE R.N. LMT

>> Massage Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1578762803

Individual Registrant:
 WANDA LYNN BLAKE R.N. LMT
Gender: F
Sole Proprietor

Location and contact information for practice:
1411 SW 252ND TER  NEWBERRY, FL 32669-4416 US
Tel: 352-472-9004  Fax: --

Contact information for business:
1411 SW 252ND TER  NEWBERRY, FL 32669-4416 US
Tel: 352-472-9004  Fax: --

Registration Information:
NPI: 1578762803
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225700000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Massage Therapist
FLMA34000

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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