MEDICARE: MS. CYNTHIA ANN SCOGGIN L.M.T.

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 #45005	FL

General Provider Information

NPI Number	:	1194977280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA ANN SCOGGIN L.M.T.

Provider Business Mailing Address
First Line	:	134 S 3RD ST
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-3956
Country	:	US
Telephone Number	:	850-830-6116
Fax Number	:

Provider Business Practice Location Address
First Line	:	10065 US HIGHWAY 98 W STE C101
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-4924
Country	:	US
Telephone Number	:	850-830-6116
Fax Number	:

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	11/17/2011

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