MEDICARE: XIAO QIAN ZHAO 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	M42050	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA 42050	OTHER	FL	MASSAGE THERAPIST

General Provider Information

NPI Number	:	1124226949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XIAO QIAN ZHAO LMT

Provider Business Mailing Address
First Line	:	PO BOX 771721
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32877-1721
Country	:	US
Telephone Number	:	407-761-1534
Fax Number	:	407-343-6116

Provider Business Practice Location Address
First Line	:	806 N MAIN ST
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-4564
Country	:	US
Telephone Number	:	407-343-6111
Fax Number	:	407-343-6116

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

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

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Directions to “ XIAO QIAN ZHAO LMT” Practice Location

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