Individual
KEVIN NOVRESKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1320 NE 2ND AVE, FORT LAUDERDALE, FL 33304-1020
(954) 467-9019
Mailing address
1320 NE 2ND AVE, FORT LAUDERDALE, FL 33304-1020
(954) 467-9019
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA 62500
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
677739200
—
FL
Enumeration date
04/15/2011
Last updated
04/15/2011
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