Provider Demographics
NPI:1689013302
Name:MAILE, DAVID PAUL (LMT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PAUL
Last Name:MAILE
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 1:12601 LAS OLAS LN
Mailing Address - Street 2:UNIT 124
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3378
Mailing Address - Country:US
Mailing Address - Phone:239-823-6481
Mailing Address - Fax:
Practice Address - Street 1:6710 WINKLER RD
Practice Address - Street 2:STE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7274
Practice Address - Country:US
Practice Address - Phone:239-823-6481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-15
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA12693225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist