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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