Individual
DIANALYNNE E FORTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
344 PASEO REYES DR, SAINT AUGUSTINE, FL 32095-8464
(904) 392-6444
Mailing address
344 PASEO REYES DR, SAINT AUGUSTINE, FL 32095-8464
(904) 392-6444
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA40618
FL
Other
Enumeration date
02/03/2009
Last updated
09/21/2010
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