MEDICARE: JULIE L ALLEN 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	MA36704	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C2690	OTHER	FL	FLORIDA BLUE

General Provider Information

NPI Number	:	1306190210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE L ALLEN LMT

Provider Business Mailing Address
First Line	:	4400 N HIGHWAY 19A # 12
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-2032
Country	:	US
Telephone Number	:	352-357-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 N HIGHWAY 19A # 12
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-2032
Country	:	US
Telephone Number	:	352-357-5000
Fax Number	:

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

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	10/30/2012

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Directions to “ JULIE L ALLEN LMT” Practice Location

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