Provider Demographics
NPI:1881491629
Name:CESIUM MASSAGE PLLC
Entity type:Organization
Organization Name:CESIUM MASSAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILFORT
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:407-403-1951
Mailing Address - Street 1:5835 ALENLON WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-8050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5835 ALENLON WAY
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-8050
Practice Address - Country:US
Practice Address - Phone:407-403-1951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251E00000XAgenciesHome Health