Provider Demographics
NPI:1386821957
Name:CARROLLWOOD MASSAGE THERAPY
Entity Type:Organization
Organization Name:CARROLLWOOD MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS-HILDERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-232-0470
Mailing Address - Street 1:14465 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2000
Mailing Address - Country:US
Mailing Address - Phone:813-961-8177
Mailing Address - Fax:813-961-3931
Practice Address - Street 1:14465 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2000
Practice Address - Country:US
Practice Address - Phone:813-961-8177
Practice Address - Fax:813-961-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-26
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM20152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty