MEDICARE: GONDEE ROWLAND 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	MA16269 MM13177	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C1468	OTHER	FL	BLUE CROSS BLUE SHIELD
2	FP2797	OTHER	FL	HEALTH NET
3	0007196354	OTHER	FL	AETNA
4	185919351390	OTHER	FL	HUMANA

General Provider Information

NPI Number	:	1710028477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GONDEE ROWLAND LMT

Provider Business Mailing Address
First Line	:	1100 SAWGRASS VILLAGE DR
Second Line	:	SUITE 201C
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5048
Country	:	US
Telephone Number	:	904-686-4002
Fax Number	:	904-273-6402

Provider Business Practice Location Address
First Line	:	1100 SAWGRASS VILLAGE DR
Second Line	:	SUITE 201C
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5048
Country	:	US
Telephone Number	:	904-686-4002
Fax Number	:	904-273-6402

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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