Individual
MR. JAMES RUFUS COULLIETTE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
33306 PORTAL DR, LEESBURG, FL 34788-3171
(352) 253-2353
Mailing address
PO BOX 895321, LEESBURG, FL 34789-5321
(352) 455-7828
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA-45688
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA-45688
LICENSED MASSAGE THERAPIST
FL
Enumeration date
08/25/2008
Last updated
08/25/2008
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