Individual
MR. JAMES ANDREW PETERNELL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
470 2ND ST N # C-1, SAFETY HARBOR, FL 34695-3600
(727) 772-3251
Mailing address
470 2ND ST N # C-1, SAFETY HARBOR, FL 34695-3600
(727) 772-3251
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 47026
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA 47026
FLORIDA MASSAGE LICENSE #
FL
01
—
MM 19426
MASSAGE ESTABLISHMENT LIC
FL
Enumeration date
06/25/2007
Last updated
07/08/2007
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