MEDICARE: JIOREL TROY ST.TROIX 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	MA49449	FL

General Provider Information

NPI Number	:	1174648091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIOREL TROY ST.TROIX LMT

Provider Business Mailing Address
First Line	:	PO BOX 5333
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33779-5333
Country	:	US
Telephone Number	:	727-559-0338
Fax Number	:

Provider Business Practice Location Address
First Line	:	MOBILE FLORIDA PRACTICE - SERVES LOCAL COUNTY AREAS AS
Second Line	:	ST.TROIX CORP, 50 - 8TH AVE SW, MS-BX5333
City	:	LARGO
State	:	FL
Zip	:	33779-5333
Country	:	US
Telephone Number	:	727-559-0338
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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