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Organization
SPACE COAST MASSAGE THERAPY INC.
Active
Organization
SPACE COAST MASSAGE THERAPY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JODY STORK I LMT (PROPRIETOR)
(321) 729-9000
Entity
Organization
Contact information
Practice address
1070 S WICKHAM RD, WEST MELBOURNE, FL 32904-1653
(321) 729-9000
(321) 722-3997
Mailing address
1070 S WICKHAM RD, WEST MELBOURNE, FL 32904-1653
(321) 729-9000
(321) 722-3997
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MM3853
FL
Other
Enumeration date
02/27/2007
Last updated
08/22/2020
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