| Doctor Name: | MRS. PHYLEISCHA MATESE MAYNE-OWEN |
| NPI Number: | 1790112795 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | H.H.P,L.M.T., C.P.T |
| License Number: | MA55794 |
| Business Practice Address: | 2658 Maguire Rd Ocoee, FL - 34761 |
| Business Phone Number: | 4073124613 |
| Business Fax Number: | 4076144122 |
| Mailing Address: | 6128 Golden Dewdrop Trail, WINDERMERE |
| State: | FL |
| Postal Code: | 34786 |
| Phone Number: | 4073124613 |
| Fax Number: | 4076144149 |
| NPI Enumeration Date: | 10/04/2013 |
| NPI Last Update Date: | 10/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | MA55794 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| 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. |