Provider Demographics
NPI:1275782989
Name:GLADWIN, EUGENIA MARITZA (LMT)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:MARITZA
Last Name:GLADWIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12718 HAMPTON PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-4126
Mailing Address - Country:US
Mailing Address - Phone:813-265-4950
Mailing Address - Fax:
Practice Address - Street 1:12718 HAMPTON PARK BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-4126
Practice Address - Country:US
Practice Address - Phone:813-265-4950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 53803225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 53803OtherMASSAGE THERAPIST