Individual
LOIS BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN LMT
Contact information
Practice address
111 N BELCHER RD, SUITE 203B, CLEARWATER, FL 33765-3257
(727) 304-3790
Mailing address
642 BELTED KINGFISHER DR N, PALM HARBOR, FL 34683-6257
(978) 505-3791
Taxonomy
Speciality
Code
Description
License number
State
163WM1400X
Nurse Massage Therapist (NMT)
9420096
FL
225700000X
Massage Therapist
Primary
80629
FL
Other
Enumeration date
06/06/2016
Last updated
07/26/2016
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