Provider Demographics
NPI:1356775423
Name:SMITH, PAULA J (LMT)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 CARILLON PKWY #130
Mailing Address - Street 2:MOUNTAIN TREE MASSAGE, LLC
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716
Mailing Address - Country:US
Mailing Address - Phone:727-202-1222
Mailing Address - Fax:
Practice Address - Street 1:400 CARILLON PKWY #130
Practice Address - Street 2:MOUNTAIN TREE MASSAGE, LLC
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716
Practice Address - Country:US
Practice Address - Phone:727-202-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA73450225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist