Individual
JOAQUINA DECEMBRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4066 EVANS AVE STE 4, FORT MYERS, FL 33901-9397
(239) 308-4050
Mailing address
3004 18TH ST SW, LEHIGH ACRES, FL 33976-3636
(239) 308-4050
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA79467
FL
Other
Enumeration date
07/03/2019
Last updated
07/03/2019
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