MEDICARE: MRS. VERA LYNN GARDNER 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	MA31752	FL
2	173C00000X	Reflexologist	MA31752	FL
3	172M00000X	Mechanotherapist	MA31752	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA31752	OTHER	FL	STATE OF FLORIDA DEPARTMENT OF HEALTH
2	290687-00	OTHER	FL	NATIONAL CERTIFICATION BOARD FOR THERAPEUTIC MASSAGE AND BODYWORK

General Provider Information

NPI Number	:	1124268537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VERA LYNN GARDNER LMT

Provider Business Mailing Address
First Line	:	5112 HEMLOCK DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4213
Country	:	US
Telephone Number	:	727-848-5006
Fax Number	:	727-848-5006

Provider Business Practice Location Address
First Line	:	5112 HEMLOCK DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4213
Country	:	US
Telephone Number	:	727-848-5006
Fax Number	:	727-848-5006

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

Provider Enumeration Date	:	02/24/2009
Last Update Date	:	12/21/2013

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