Provider Demographics
NPI:1972646172
Name:MASSAGE THERAPY, HEALTH AND RELAXATION CENTER
Entity Type:Organization
Organization Name:MASSAGE THERAPY, HEALTH AND RELAXATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, MCCC
Authorized Official - Phone:407-858-0779
Mailing Address - Street 1:600 W OAK RIDGE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4825
Mailing Address - Country:US
Mailing Address - Phone:407-858-0779
Mailing Address - Fax:407-858-0443
Practice Address - Street 1:600 W OAK RIDGE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4825
Practice Address - Country:US
Practice Address - Phone:407-858-0779
Practice Address - Fax:407-858-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0007273225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA0007273OtherLIC. MASSAGE THERAPY