Organization
GO MADD 4 MASSAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA CAROL BERANEK (OWNER)
(904) 708-1083
Entity
Organization
Contact information
Practice address
2600 US HIGHWAY 1 S STE 7, ST AUGUSTINE, FL 32086-6193
(904) 708-1083
Mailing address
2600 US HIGHWAY 1 S STE 7, ST AUGUSTINE, FL 32086-6193
(904) 708-1083
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MM16790
FL
Other
Enumeration date
09/07/2016
Last updated
09/07/2016
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