=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881949303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA ALEXANDRIA ST MARY DURLING LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2012
-----------------------------------------------------
Last Update Date | 07/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 INDIAN RIVER BLVD SUITE A-135
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-5627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-978-9750
-----------------------------------------------------
Fax | 772-978-9748
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2225 15TH ST
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-3194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-360-8996
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | MA65361
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------