Organization
COAST TO COAST MASSAGE THERAPY BY JEREMY MINNICK INC.
Active
Organization
COAST TO COAST MASSAGE THERAPY BY JEREMY MINNICK INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEREMY A MINNICK LMT (PRESIDENT / OWNER)
(239) 671-9900
Entity
Organization
Contact information
Practice address
2143 NW 17TH AVE, CAPE CORAL, FL 33993-3101
(239) 671-9900
Mailing address
2143 NW 17TH AVE, CAPE CORAL, FL 33993-3101
(239) 671-9900
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA25921
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C3738
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/19/2012
Last updated
07/19/2012
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