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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