MEDICARE: GARY DAVID PAJONK R.N., 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	163WM1400X	Nurse Massage Therapist (NMT)	FL RN 1038922	FL
2	225700000X	Massage Therapist	MA 5079	FL

General Provider Information

NPI Number	:	1245540244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY DAVID PAJONK R.N., L.M.T.

Provider Business Mailing Address
First Line	:	3411 BONITA BEACH RD
Second Line	:	SUITE 305
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-4155
Country	:	US
Telephone Number	:	239-992-5498
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 BONITA BEACH RD
Second Line	:	SUITE 305
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-4155
Country	:	US
Telephone Number	:	239-992-5498
Fax Number	:

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

Provider Enumeration Date	:	10/09/2010
Last Update Date	:	10/09/2010

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