Individual
LIDICE MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2422 WOODY TRACE LN, TAMPA, FL 33612-7121
(813) 325-0139
Mailing address
2422 WOODY TRACE LN, TAMPA, FL 33612-7121
(813) 325-0139
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA53483
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA53483
LICENSED MEDICAL PRACTITIONER
FL
Enumeration date
11/22/2019
Last updated
11/22/2019
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