Provider Demographics
NPI:1538662333
Name:NIVEN, DOUGLAS E (LMT)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:NIVEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S ORANGE AVE STE 301D
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-7504
Mailing Address - Country:US
Mailing Address - Phone:941-531-1462
Mailing Address - Fax:
Practice Address - Street 1:630 S ORANGE AVE STE 301D
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7504
Practice Address - Country:US
Practice Address - Phone:941-531-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA79436225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist