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Individual

FANG WANG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4575 KEY LARGO LN, BONITA SPRINGS, FL 34134-7225
(239) 961-3033
Mailing address
4575 KEY LARGO LN, BONITA SPRINGS, FL 34134-7225

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA 55656
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MA 55656
MASSAGE THERAPIST
FL
Enumeration date
08/10/2014
Last updated
08/10/2014
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