Provider Demographics
NPI:1023254877
Name:BATES, RICK (LMT)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:
Last Name:BATES
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 1:4443 HAWKSLEY PL
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-5218
Mailing Address - Country:US
Mailing Address - Phone:813-995-3264
Mailing Address - Fax:813-377-4886
Practice Address - Street 1:5801 ARGERIAN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33545-4140
Practice Address - Country:US
Practice Address - Phone:813-995-3264
Practice Address - Fax:813-377-4886
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA11025174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA11025OtherFLORIDA DEPARTMENT OF HEALTH MASSAGE LICENSE