Individual
AMY BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
2115 MORGAN WIELAND LN, APT 106, LAKELAND, FL 33813-3181
(407) 490-8581
Mailing address
2115 MORGAN WIELAND LN, APT 106, LAKELAND, FL 33813-3181
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA47344
FL
Other
Enumeration date
04/30/2017
Last updated
04/30/2017
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