Organization
GENTLE STICKS ON WHEELS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALYSHA PETTIS (OWNER)
(352) 431-1193
Entity
Organization
Contact information
Practice address
1829 FOREST GLEN DR, FRUITLAND PARK, FL 34731-6565
(352) 431-1193
Mailing address
1829 FOREST GLEN DR, FRUITLAND PARK, FL 34731-6565
(352) 431-1193
Taxonomy
Speciality
Code
Description
License number
State
246R00000X
Pathology Technician
—
—
374700000X
Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942884846
—
FL
Enumeration date
07/29/2021
Last updated
09/13/2021
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