MEDICARE: ALYSE COSIMA RODRIGUEZ 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	MA 59574	FL

General Provider Information

NPI Number	:	1033418165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSE COSIMA RODRIGUEZ LMT

Provider Business Mailing Address
First Line	:	8450 GATE PKWY W # 16254
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1049
Country	:	US
Telephone Number	:	904-352-5292
Fax Number	:

Provider Business Practice Location Address
First Line	:	3576 SAINT JOHNS AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-8446
Country	:	US
Telephone Number	:	904-387-9355
Fax Number	:	904-387-6701

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

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	03/15/2011

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