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NPI Code Detail

MEDICARE: MRS. CELESTE PONUSHIS MCCRORY L.M.T.

MEDICARE: MRS. CELESTE PONUSHIS MCCRORY 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
1225700000XMassage TherapistMA 26527FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C2452OTHERFLBLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number : 1225262462
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CELESTE PONUSHIS MCCRORY L.M.T.
Provider Business Mailing Address
First Line : PO BOX 915065
Second Line :
City : LONGWOOD
State : FL
Zip : 32791-5065
Country : US
Telephone Number : 407-497-7353
Fax Number :
Provider Business Practice Location Address
First Line : 488 S HUNT CLUB BLVD
Second Line :
City : APOPKA
State : FL
Zip : 32703-4948
Country : US
Telephone Number : 407-497-7353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2009
Last Update Date : 05/02/2009

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