Provider Demographics
NPI:1205260619
Name:MUSSELWHITE, BRUCE ALAN (LMT)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALAN
Last Name:MUSSELWHITE
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 1:4526 SW 47TH WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4912
Mailing Address - Country:US
Mailing Address - Phone:352-279-4010
Mailing Address - Fax:
Practice Address - Street 1:4526 SW 47TH WAY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4912
Practice Address - Country:US
Practice Address - Phone:352-279-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 73712225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist