Provider Demographics
NPI:1760646145
Name:TAYLOR, SELENA BLOSSOM (LICENSED MASSAGE THE)
Entity Type:Individual
Prefix:MS
First Name:SELENA
Middle Name:BLOSSOM
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5100 SW 41ST ST
Mailing Address - Street 2:APT 203
Mailing Address - City:PEMBROKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023
Mailing Address - Country:US
Mailing Address - Phone:407-953-1497
Mailing Address - Fax:
Practice Address - Street 1:570 OCEAN DR
Practice Address - Street 2:#501 HOLISTIC MASSAGE & WELLNESS CLINICS
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?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA53439OtherLMT LICENSE