Individual
DANIELLE THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3302 CARNINE DR, ORLANDO, FL 32806-7428
(407) 873-7227
Mailing address
3302 CARNINE DR, ORLANDO, FL 32806-7428
(407) 873-7227
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA41180
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA41180
LICENSED MASSAGE THERAPIST
FL
Enumeration date
01/12/2012
Last updated
01/12/2012
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