MEDICARE: MRS. PATRICIA J ANASTASIO II

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	MA40371	FL

General Provider Information

NPI Number	:	1427238427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA J ANASTASIO II

Provider Business Mailing Address
First Line	:	690 HUNTERS RUN BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-6654
Country	:	US
Telephone Number	:	863-670-0335
Fax Number	:	863-858-1516

Provider Business Practice Location Address
First Line	:	1203 MAYFLOWER DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-3621
Country	:	US
Telephone Number	:	863-670-0335
Fax Number	:	863-858-1516

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

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	11/07/2007

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