Individual
KEVIN MICHAEL DONOVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
12115 PANAMA CITY BEACH PKWY, PANAMA CITY BEACH, FL 32407-2609
(850) 236-5664
Mailing address
4932 BEACH DR, PANAMA CITY BEACH, FL 32408-6801
(850) 596-5621
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA 44336
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C3954
BLUECROSS BLUESHIELD
FL
Enumeration date
04/09/2007
Last updated
07/08/2007
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