MEDICARE: PETE PFANNERSTILL PH.D., LMT, CKTI

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	MA24089	FL

General Provider Information

NPI Number	:	1457374894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETE PFANNERSTILL PH.D., LMT, CKTI

Provider Business Mailing Address
First Line	:	1936 W DR MARTIN LUTHER KING JR BLVD STE 103
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6530
Country	:	US
Telephone Number	:	813-482-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1936 W DR MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE 103
City	:	TAMPA
State	:	FL
Zip	:	33607-6500
Country	:	US
Telephone Number	:	813-875-5872
Fax Number	:	813-870-2324

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	02/17/2018

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