Provider Demographics
NPI:1336205038
Name:MUSSELWHITE, SANDRA (LMT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MUSSELWHITE
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 1:1004 VENETIAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-2132
Mailing Address - Country:US
Mailing Address - Phone:407-435-8850
Mailing Address - Fax:407-532-9250
Practice Address - Street 1:1004 VENETIAN AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-2132
Practice Address - Country:US
Practice Address - Phone:407-435-8850
Practice Address - Fax:407-532-9250
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA45011225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLUNKNOWNOtherBCBS