Individual
KEITH ALEXANDER VIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11321 TORCHWOOD CT, WELLINGTON, FL 33414-6024
(757) 231-6717
Mailing address
PO BOX 212041, ROYAL PALM BEACH, FL 33421-2041
(757) 231-6717
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA97864
FL
Other
Enumeration date
08/27/2021
Last updated
08/27/2021
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