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Individual

CHANNING RANGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1151 NW 24TH AVE, POMPANO BEACH, FL 33069-1824
(754) 214-1017
Mailing address
1151 NW 24TH AVE, POMPANO BEACH, FL 33069-1824
(754) 214-1017

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA 48484
FL

Other

Enumeration date
12/11/2008
Last updated
12/11/2008
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