Individual
MS. JANICE L. VIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4027 N LECANTO HWY, BEVERLY HILLS, FL 34465-3551
(352) 527-2515
Mailing address
897 N HOLLYWOOD CIR, CRYSTAL RIVER, FL 34429-2644
(352) 795-3191
(352) 795-3191
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA#43019
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C2917
BCBS PROVIDER NUMBER
FL
01
—
MA#43019
MASSAGE LICENSE
FL
Enumeration date
12/04/2006
Last updated
07/08/2007
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