Provider Demographics
NPI:1720243728
Name:WELLS, LORRAINE BRADSHAW (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:BRADSHAW
Last Name:WELLS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 HUDSON LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-5340
Mailing Address - Country:US
Mailing Address - Phone:813-264-7688
Mailing Address - Fax:813-264-7850
Practice Address - Street 1:3921 HUDSON LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-5340
Practice Address - Country:US
Practice Address - Phone:813-264-7688
Practice Address - Fax:813-264-7850
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-19
Last Update Date:2008-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31526225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist