Provider Demographics
NPI:1447502364
Name:FLEMING, PATRICIA NICOLE (LMT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:NICOLE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27350 BENT FORK RD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-7307
Mailing Address - Country:US
Mailing Address - Phone:352-807-2650
Mailing Address - Fax:
Practice Address - Street 1:7050 GALL BOULEVARD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541
Practice Address - Country:US
Practice Address - Phone:813-783-6123
Practice Address - Fax:813-715-6632
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA50633225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist