Provider Demographics
NPI:1275819005
Name:GRACA, ANETA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:ANETA
Middle Name:
Last Name:GRACA
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22807
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-2807
Mailing Address - Country:US
Mailing Address - Phone:813-876-7246
Mailing Address - Fax:813-871-1437
Practice Address - Street 1:3105 W BAY TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7211
Practice Address - Country:US
Practice Address - Phone:813-835-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA41225174V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174V00000XOther Service ProvidersClinical Ethicist