MEDICARE: LASHAWNTE ZAKIEK MCCRAW SR. NMT

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	MA45278	FL

General Provider Information

NPI Number	:	1104000454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHAWNTE ZAKIEK MCCRAW SR. NMT

Provider Business Mailing Address
First Line	:	869 STOCKTON ST
Second Line	:	SUITE 3
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3590
Country	:	US
Telephone Number	:	904-388-1300
Fax Number	:	904-388-1302

Provider Business Practice Location Address
First Line	:	869 STOCKTON ST
Second Line	:	SUITE 3
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3590
Country	:	US
Telephone Number	:	904-388-1300
Fax Number	:	904-388-1302

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

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	03/17/2008

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