MEDICARE: SUZANNE MARGOLIS-GRAY MASSAGE THERAPIST

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	MA7629	FL

General Provider Information

NPI Number	:	1588837785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE MARGOLIS-GRAY MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	1007 N MACDILL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5126
Country	:	US
Telephone Number	:	813-871-3200
Fax Number	:	813-877-2640

Provider Business Practice Location Address
First Line	:	1007 N MACDILL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5126
Country	:	US
Telephone Number	:	813-871-3200
Fax Number	:	813-877-2640

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

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	04/08/2008

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