Individual
HANSEL F OUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
4200 HAYES ST, HOLLYWOOD, FL 33021-5362
(954) 779-6216
Mailing address
4200 HAYES ST, HOLLYWOOD, FL 33021-5362
(954) 779-6216
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA0017981
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
612595300
OWCP - ACS
FL
Enumeration date
01/18/2012
Last updated
01/18/2012
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