Individual
GLENN RANDOLPH GAFFNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2225 A1A S, SUITE B-1, ST AUGUSTINE, FL 32080-2916
(904) 461-9901
Mailing address
2225 A1A S, SUITE B-1, ST AUGUSTINE, FL 32080-2916
(904) 461-9901
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA002007
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA002007
FL MASSAGE THERAPY LIC #
FL
Enumeration date
03/19/2007
Last updated
07/08/2007
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