MEDICARE: MRS. LEIAH JEANINE CARR 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	MA 29890	FL

General Provider Information

NPI Number	:	1558486407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEIAH JEANINE CARR LMT

Provider Business Mailing Address
First Line	:	6325 ARLINGTON RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5423
Country	:	US
Telephone Number	:	904-477-2277
Fax Number	:	904-744-8038

Provider Business Practice Location Address
First Line	:	6325 ARLINGTON RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5423
Country	:	US
Telephone Number	:	904-477-2277
Fax Number	:	904-744-8038

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/09/2007

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