MEDICARE: INTUITIVE MASSAGE, INC.

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	171100000X	Acupuncturist	AP2428	FL
2	225700000X	Massage Therapist	MA40195	FL
3	225700000X	Massage Therapist	MA73340	FL
4	225700000X	Massage Therapist	MA27257	FL

General Provider Information

NPI Number	:	1275946949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTUITIVE MASSAGE, INC.

Provider Business Mailing Address
First Line	:	943 MALL RING RD
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-8515
Country	:	US
Telephone Number	:	863-402-2208
Fax Number	:

Provider Business Practice Location Address
First Line	:	943 MALL RING RD
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-8515
Country	:	US
Telephone Number	:	863-402-2208
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CHARLENE ANN NIKOLAKAKIS
Credential	:	LMT
Telephone Number	:	863-402-2208

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	06/10/2014

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