Provider Demographics
NPI:1487661005
Name:VENCIL, D R (LMT)
Entity type:Individual
Prefix:
First Name:D R
Middle Name:
Last Name:VENCIL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SAN PABLO RD S
Mailing Address - Street 2:#301
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2063
Mailing Address - Country:US
Mailing Address - Phone:904-233-6526
Mailing Address - Fax:
Practice Address - Street 1:1700 SAN PABLO RD S
Practice Address - Street 2:#301
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2063
Practice Address - Country:US
Practice Address - Phone:904-233-6526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 31662225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA31662OtherLICENSE NUMBER