MEDICARE: ERICA MARIE DEAN 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	MA 49121	FL

General Provider Information

NPI Number	:	1114058625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA MARIE DEAN LMT

Provider Business Mailing Address
First Line	:	36651 SKYCREST BLVD
Second Line	:
City	:	FRUITLAND PARK
State	:	FL
Zip	:	34731-5457
Country	:	US
Telephone Number	:	352-223-4520
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 N BAY ST STE 2
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-2964
Country	:	US
Telephone Number	:	352-223-4520
Fax Number	:

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

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

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