MEDICARE: MRS. CHRISTY ANGELA STEVENS-DOUGLAS LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA38414	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C2519	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1033248455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTY ANGELA STEVENS-DOUGLAS LMT

Provider Business Mailing Address
First Line	:	8747 MARTIN LN
Second Line	:
City	:	ZOLFO SPRINGS
State	:	FL
Zip	:	33890-2824
Country	:	US
Telephone Number	:	863-784-0494
Fax Number	:

Provider Business Practice Location Address
First Line	:	8747 MARTIN LN
Second Line	:
City	:	ZOLFO SPRINGS
State	:	FL
Zip	:	33890-2824
Country	:	US
Telephone Number	:	863-784-0494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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