Provider Demographics
NPI:1598944548
Name:SUN, YUDITH RODRIGUEZ (LMT)
Entity Type:Individual
Prefix:MRS
First Name:YUDITH
Middle Name:RODRIGUEZ
Last Name:SUN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:YUDITH
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2019 WILEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020
Mailing Address - Country:US
Mailing Address - Phone:954-456-9043
Mailing Address - Fax:
Practice Address - Street 1:570 OCEAN DR
Practice Address - Street 2:#59 HOLISTIC MASSAGE & WELLNESS CLINIC
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408
Practice Address - Country:US
Practice Address - Phone:954-491-2225
Practice Address - Fax:954-491-6862
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22698OtherLMT