Individual
DOROTHY J KELLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
115 TAMIAMI TRAIL, SUITE 9, NOKOMIS, FL 34275
(941) 493-8596
(941) 493-8596
Mailing address
1790 POMELO DRIVE, VENICE, FL 34293-2716
(941) 493-8596
(941) 493-8596
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA0016808
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C6078
BCBS
FL
Enumeration date
04/23/2008
Last updated
04/23/2008
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