MEDICARE: MR. JOHN WILLIAM DAVIDSON 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#8526	FL

General Provider Information

NPI Number	:	1063617892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN WILLIAM DAVIDSON LMT

Provider Business Mailing Address
First Line	:	PO BOX 151254
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32715-1254
Country	:	US
Telephone Number	:	407-228-0372
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-5312
Country	:	US
Telephone Number	:	407-423-0038
Fax Number	:

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

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	07/08/2007

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