Provider Demographics
NPI:1851606479
Name:SCIPIO, KWASI HEZEKIAH (MA, LMT)
Entity Type:Individual
Prefix:
First Name:KWASI
Middle Name:HEZEKIAH
Last Name:SCIPIO
Suffix:
Gender:M
Credentials:MA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1316
Mailing Address - Country:US
Mailing Address - Phone:813-237-2434
Mailing Address - Fax:
Practice Address - Street 1:1201 WEST HILLSBOROUGH AVENUE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603
Practice Address - Country:US
Practice Address - Phone:813-237-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59561225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist