Organization
FOOTPRINTS ON THE MOON MASSAGE AND BODYWORK, LLC
Active
Organization
FOOTPRINTS ON THE MOON MASSAGE AND BODYWORK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA JO FAGNANT LMT (OWNER/THERAPIST)
(407) 436-2122
Entity
Organization
Contact information
Practice address
1312 ILLINOIS AVE, SUITE E, SAINT CLOUD, FL 34769-4506
(407) 436-2122
Mailing address
1312 ILLINOIS AVE, SUITE E, SAINT CLOUD, FL 34769-4506
(407) 436-2122
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MM32405
FL
Other
Enumeration date
07/01/2014
Last updated
07/01/2014
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