Individual
MR. LADON STACY LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
3650 NANTUCKET ISLAND DR, APT. 101, PORT ORANGE, FL 32129-5336
(386) 679-4996
(386) 322-3870
Mailing address
PO BOX 422, DAYTONA BEACH, FL 32115-0422
(386) 679-4996
(386) 322-3870
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA52351
FL
Other
Enumeration date
05/26/2008
Last updated
05/26/2008
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