Provider Demographics
NPI:1639203219
Name:SPODAK, ILANA FAITH (LMT, CNMT)
Entity Type:Individual
Prefix:MS
First Name:ILANA
Middle Name:FAITH
Last Name:SPODAK
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SE 15TH TER
Mailing Address - Street 2:SUITE 212
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4464
Mailing Address - Country:US
Mailing Address - Phone:954-288-6375
Mailing Address - Fax:
Practice Address - Street 1:201 SE 15TH TER
Practice Address - Street 2:SUITE 212
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4464
Practice Address - Country:US
Practice Address - Phone:561-642-1408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 23450225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 23450OtherFLORIDA BOARD OF MASSAGE THERAPY