Individual
LADIA SHAQWUNTA PAULK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
412 LONGFELLOW BLVD STE 2, LAKELAND, FL 33801-2404
(863) 272-0906
Mailing address
585 W PIERCE ST, LAKE ALFRED, FL 33850-2625
(863) 272-0906
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
74105
FL
Other
Enumeration date
07/20/2017
Last updated
03/17/2018
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