Organization
KEEP YOUNG MASSAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLEN TIMOTHY STANLEY PRAC MA85566 (PRACTITIONER THERAPIST)
(352) 561-2991
Entity
Organization
Contact information
Practice address
510 CO. ROAD 466, SUITE 207, LADY LAKE, FL 32159
(352) 561-2991
Mailing address
510 CO. ROAD 466, SUITE 207, LADY LAKE, FL 32159
(352) 561-2991
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
07/12/2024
Last updated
07/12/2024
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