MEDICARE: ADRIANE CARDOSO I 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	MA91702	FL

General Provider Information

NPI Number	:	1073127387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIANE CARDOSO I LMT

Provider Business Mailing Address
First Line	:	642 SE STREAMLET AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-4658
Country	:	US
Telephone Number	:	954-512-7611
Fax Number	:

Provider Business Practice Location Address
First Line	:	642 SE STREAMLET AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-4658
Country	:	US
Telephone Number	:	954-512-7611
Fax Number	:

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

Provider Enumeration Date	:	09/03/2020
Last Update Date	:	09/03/2020

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Directions to “ ADRIANE CARDOSO I LMT” Practice Location

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