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NPI Code Detail

MEDICARE: DAWN M THIBODEAU LMT

MEDICARE:   DAWN M THIBODEAU  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
1225700000XMassage TherapistMA 51517FL

General Provider Information

NPI Number : 1083861629
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAWN M THIBODEAU LMT
Provider Business Mailing Address
First Line : 300 SUN OAKS CT
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-3007
Country : US
Telephone Number : 407-415-2201
Fax Number :
Provider Business Practice Location Address
First Line : 130 E ALTAMONTE DR
Second Line :
City : ALTAMONTE SPRINGS
State : FL
Zip : 32701-4338
Country : US
Telephone Number : 407-831-0100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2008
Last Update Date : 08/26/2008

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Directions to “ DAWN M THIBODEAU LMT” Practice Location

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