Individual
GLORIA JEAN SHACKELFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
114 W ORANGE ST, WAUCHULA, FL 33873
(863) 773-5646
Mailing address
114 W ORANGE ST, WAUCHULA, FL 33873-2826
(863) 773-5646
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA33289
FL
Other
Enumeration date
04/02/2015
Last updated
04/02/2015
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