Organization
THAI MEDICAL MASSAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
POUNGSRI VONBERNUTH LMT (OWNER / THERAPIST)
(813) 685-2315
Entity
Organization
Contact information
Practice address
110 E WINDHORST RD, BRANDON, FL 33510-2524
(813) 685-2315
(813) 685-2399
Mailing address
110 E WINDHORST RD, BRANDON, FL 33510-2524
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
MA13798
FL
261Q00000X
Clinic/Center
Primary
MM11331
FL
Other
Enumeration date
03/17/2008
Last updated
06/16/2008
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