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Organization
MUDDY MANTRA LLC
Active
Organization
MUDDY MANTRA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELODIE LEE MORENO ERYT-500 YCAEP (MANAGER)
(727) 422-3954
Entity
Organization
Contact information
Practice address
3460 TAMPA RD, PALM HARBOR, FL 34684-3530
(727) 422-3954
Mailing address
3460 TAMPA RD, PALM HARBOR, FL 34684-3530
(727) 422-3954
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
09/10/2021
Last updated
09/21/2021
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