Provider Demographics
NPI:1710175377
Name:UNIVERSITY SPORTS MASSAGE INC.
Entity Type:Organization
Organization Name:UNIVERSITY SPORTS MASSAGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBRA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:352-373-6869
Mailing Address - Street 1:920 NW 8TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5071
Mailing Address - Country:US
Mailing Address - Phone:352-373-6869
Mailing Address - Fax:
Practice Address - Street 1:920 NW 8TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5071
Practice Address - Country:US
Practice Address - Phone:352-373-6869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM20162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty