Provider Demographics
NPI:1548602881
Name:CLERMONT MASSAGE LLC
Entity Type:Organization
Organization Name:CLERMONT MASSAGE LLC
Other - Org Name:PURE WELLNESS COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:352-577-0600
Mailing Address - Street 1:552 S HIGHWAY 27
Mailing Address - Street 2:STE B
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-2705
Mailing Address - Country:US
Mailing Address - Phone:352-577-0600
Mailing Address - Fax:
Practice Address - Street 1:552 S HIGHWAY 27
Practice Address - Street 2:STE B
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-2705
Practice Address - Country:US
Practice Address - Phone:352-577-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3024171100000X
FLMA60330173C00000X, 225500000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Single Specialty
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty