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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