MEDICARE: LARRY GENE DEARFIELD MA47738

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	MA47738	FL

General Provider Information

NPI Number	:	1902034978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY GENE DEARFIELD MA47738

Provider Business Mailing Address
First Line	:	4611 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-1121
Country	:	US
Telephone Number	:	407-451-0219
Fax Number	:

Provider Business Practice Location Address
First Line	:	4611 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-1121
Country	:	US
Telephone Number	:	407-451-0219
Fax Number	:

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

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/29/2009

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