=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497972939
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE M GORECKI LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2007
-----------------------------------------------------
Last Update Date | 04/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 942 WOODGATE DR
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34685-1645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-937-7788
-----------------------------------------------------
Fax | 727-937-7788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 BAY ARBOR BLVD
-----------------------------------------------------
City | OLDSMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34677-4664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-855-5427
-----------------------------------------------------
Fax | 727-937-9977
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA47861
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------