Individual
KEEGAN RYAN FLAME THROWER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
15215 US HIGHWAY 19, SUITE H, HUDSON, FL 34667-3675
(727) 828-7070
Mailing address
4321 PLAZA DR, D106, HOLIDAY, FL 34691-2815
(305) 240-5755
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA61730
FL
Other
Enumeration date
06/01/2012
Last updated
06/01/2012
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