Provider Demographics
NPI:1548425705
Name:SABULA, JOAN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:
Last Name:SABULA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 S BAY ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6587
Mailing Address - Country:US
Mailing Address - Phone:352-552-5430
Mailing Address - Fax:
Practice Address - Street 1:2755 S BAY ST
Practice Address - Street 2:SUITE E
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6587
Practice Address - Country:US
Practice Address - Phone:352-552-5430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-26
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40952225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist