Doctor Name: | JERROD A GAUTHIER |
NPI Number: | 1760732556 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMT |
License Number: | MA44066 |
Business Practice Address: | 3135 State Road 580 Suite 11 Safety Harbor, FL - 346954976 |
Business Phone Number: | 8133260404 |
Business Fax Number: | |
Mailing Address: | 318 Westminster Blvd, OLDSMAR |
State: | FL |
Postal Code: | 346774620 |
Phone Number: | 8133260404 |
Fax Number: | |
NPI Enumeration Date: | 09/19/2012 |
NPI Last Update Date: | 09/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA44066 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | 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. |