MEDICARE: MRS. LINDA LEE GAGNON

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 10723	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144429531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA LEE GAGNON

Provider Business Mailing Address
First Line	:	4349 FORT SHAW DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-7316
Country	:	US
Telephone Number	:	727-278-5690
Fax Number	:	727-372-0970

Provider Business Practice Location Address
First Line	:	4349 FORT SHAW DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-7316
Country	:	US
Telephone Number	:	727-278-5690
Fax Number	:	727-372-0970

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

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	07/16/2007

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