Footprints On the Moon Massage and Bodywork, LLC

NPI #1760898506 in Saint Cloud, Florida

Provider Information

NPI Number: 1760898506
Entity Type: Organization
Organization Name: Footprints On the Moon Massage and Bodywork, LLC
Primary Specialty: Massage Therapist
Enumeration Date: Jul 1, 2014
Last Updated: Jul 1, 2014

Practice Location

Address: 1312 ILLINOIS AVE
Address 2: SUITE E
City: Saint Cloud
State: Florida
ZIP Code: 34769-4506
Phone: (407) 436-2122

Authorized Official

Name: SAMANTHA JO FAGNANT, LMT
Title: OWNER/THERAPIST
Phone: (407) 436-2122

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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