Provider Demographics
NPI:1215157052
Name:SEYOUM, ZENEBEWORK
Entity type:Individual
Prefix:
First Name:ZENEBEWORK
Middle Name:
Last Name:SEYOUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HOLISTIC MASSAGE &WELLENESS CLINIC
Mailing Address - Street 2:903 E. CYPRESS CREEK RD
Mailing Address - City:FORT.LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334
Mailing Address - Country:US
Mailing Address - Phone:954-491-2225
Mailing Address - Fax:954-491-6862
Practice Address - Street 1:HOLISTIC MASSAGE&WELLNESS CLINICS
Practice Address - Street 2:903 E. CYPRESS CREEK RD
Practice Address - City:FORTLAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334
Practice Address - Country:US
Practice Address - Phone:954-491-2225
Practice Address - Fax:954-491-6862
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40206225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist