DIVERSIFIED THERAPEUTICS INC NPI 1700027984

NPI Information

NPI: 1700027984
Provider Name: DIVERSIFIED THERAPEUTICS INC
Classification: Massage Therapist - 225700000X
Entity Type: Organization
Address:
613 SE CENTRAL PARKWAY
STUART, FL
ZIP 34994
Phone: (772) 221-7638
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DIVERSIFIED THERAPEUTICS INC is a massage therapist in Stuart, FL. The provider is an individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. DIVERSIFIED THERAPEUTICS INC NPI is 1700027984. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

613 SE CENTRAL PARKWAY
STUART, FL
ZIP 34994
Phone: (772) 221-7638
Fax: (772) 221-7628

The provider's authorized official is Calvin Lee Jackson .
The authorized official title is President/licensed Massage Therapis and has the following contact phone number (772) 221-7638.

The enumeration date for this NPI number is 3/17/2009 and was last updated on 3/17/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	225700000X	Massage Therapist		MA0018459	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	C8068	OTHER	FLORIDA	BLUE CROSS BLUE SHIELD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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