Provider Demographics
NPI:1649676644
Name:WHITTINGTON, JAIME (LICENSED MASSAGE THE)
Entity type:Individual
Prefix:MR
First Name:JAIME
Middle Name:
Last Name:WHITTINGTON
Suffix:
Gender:M
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 57TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7931
Mailing Address - Country:US
Mailing Address - Phone:727-744-3326
Mailing Address - Fax:
Practice Address - Street 1:249 57TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7931
Practice Address - Country:US
Practice Address - Phone:727-744-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA39977225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist