Provider Demographics
NPI:1255930376
Name:RECA, JANE VITORINO (LMT)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:VITORINO
Last Name:RECA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:VITORINO
Other - Last Name:MORAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:821 DOVE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3705
Mailing Address - Country:US
Mailing Address - Phone:786-503-5444
Mailing Address - Fax:
Practice Address - Street 1:1005 N LAKE PARKER AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4723
Practice Address - Country:US
Practice Address - Phone:863-583-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA75135225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist