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Organization

LE CAMELOT LLC

Active
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Organization

LE CAMELOT LLC

Active
Other names
Le Camelot Wellness Spa
Organization subpart
No

Provider details

NPI number
Authorized official
MS. SANDRA BROOKS SOULE LMT (LMT/OWNER)
(813) 774-4475
Entity
Organization

Contact information

Practice address
19923 JODI DR, LUTZ, FL 33558-5005
(813) 774-4475
(813) 435-2001
Mailing address
19923 JODI DR, LUTZ, FL 33558-5005
(813) 774-4475
(813) 435-2001

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA005943
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1285961037
INDIVIDUAL NPI
FL
01
9566677
AETNA
FL
Enumeration date
07/21/2011
Last updated
07/21/2011
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