MEDICARE: ELSA RINCON 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	MA31675	FL

General Provider Information

NPI Number	:	1063586469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELSA RINCON LMT

Provider Business Mailing Address
First Line	:	713 SUNNY PINE WAY APT D1
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33415-8971
Country	:	US
Telephone Number	:	561-296-0979
Fax Number	:

Provider Business Practice Location Address
First Line	:	713 SUNNY PINE WAY APT D1
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33415-8971
Country	:	US
Telephone Number	:	561-296-0979
Fax Number	:

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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