Provider Demographics
NPI:1235426164
Name:SPALDING, PATRICE (LMT)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:SPALDING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JOYA
Other - Middle Name:
Other - Last Name:SPALDING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1400 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4400
Mailing Address - Country:US
Mailing Address - Phone:561-504-6824
Mailing Address - Fax:
Practice Address - Street 1:1400 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE # 201
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4400
Practice Address - Country:US
Practice Address - Phone:561-504-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA21110225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist