MEDICARE: MS. CAROL A CARBONE 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 29024	FL

General Provider Information

NPI Number	:	1811015696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL A CARBONE LMT

Provider Business Mailing Address
First Line	:	1334 TIMBERLANE RD
Second Line	:	SUITE 4
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1766
Country	:	US
Telephone Number	:	850-668-0508
Fax Number	:	850-907-8245

Provider Business Practice Location Address
First Line	:	1334 TIMBERLANE RD
Second Line	:	SUITE 4
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1766
Country	:	US
Telephone Number	:	850-668-0508
Fax Number	:	850-907-8245

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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