Provider Demographics
NPI:1689818742
Name:SACLA, GEORGE DOSDOS (LMT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:DOSDOS
Last Name:SACLA
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 1:339 RACETRACK RD NW
Mailing Address - Street 2:SUITE 12
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1538
Mailing Address - Country:US
Mailing Address - Phone:850-368-3393
Mailing Address - Fax:850-398-5923
Practice Address - Street 1:339 RACETRACK RD NW
Practice Address - Street 2:SUITE 12
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1538
Practice Address - Country:US
Practice Address - Phone:850-368-3393
Practice Address - Fax:850-398-5923
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 39398225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
22231OtherAUTOMOBILE ACCIDENT INSURANCE (PIP)
FL39398OtherBLUE CROSS AND BLUE SHIELD
FL22203OtherWORKERS COMP.