Provider Demographics
NPI:1902074578
Name:SGI MASSAGE LLC
Entity Type:Organization
Organization Name:SGI MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YUKIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:TUBAUDO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:407-595-7461
Mailing Address - Street 1:9376 MUSTARD LEAF DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827
Mailing Address - Country:US
Mailing Address - Phone:407-595-7461
Mailing Address - Fax:
Practice Address - Street 1:6150 METROWEST BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835
Practice Address - Country:US
Practice Address - Phone:407-595-7461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SGI MASSAGE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-15
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38404225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA38404OtherMASSAGE THERAPY