Individual
KEVIN MASON BANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1813 BRUMLEY RD, CHULUOTA, FL 32766-9018
(407) 416-3223
Mailing address
1813 BRUMLEY RD, CHULUOTA, FL 32766-9018
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
51521
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
693226600
—
FL
Enumeration date
10/19/2017
Last updated
10/19/2017
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