MEDICARE: MICHAEL IADAROLA L.M.T.

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	MA26011	FL

General Provider Information

NPI Number	:	1003160268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL IADAROLA L.M.T.

Provider Business Mailing Address
First Line	:	4124 LAKE UNDERHILL RD APT 108
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-7086
Country	:	US
Telephone Number	:	321-217-8228
Fax Number	:

Provider Business Practice Location Address
First Line	:	4124 LAKE UNDERHILL RD APT 108
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-7086
Country	:	US
Telephone Number	:	321-217-8228
Fax Number	:

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

Provider Enumeration Date	:	11/08/2012
Last Update Date	:	11/08/2012

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