MEDICARE: VINCENT THOMAS 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	MA40685	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA40685	OTHER	FL	STATE LICENSE
2	C2872	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1952429771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT THOMAS LMT

Provider Business Mailing Address
First Line	:	PO BOX 534
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32170-0534
Country	:	US
Telephone Number	:	386-427-4743
Fax Number	:	386-427-5245

Provider Business Practice Location Address
First Line	:	812 W INDIAN RIVER BLVD
Second Line	:
City	:	EDGEWATER
State	:	FL
Zip	:	32132-3429
Country	:	US
Telephone Number	:	386-427-4743
Fax Number	:	386-427-5245

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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Directions to “ VINCENT THOMAS LMT” Practice Location

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