MEDICARE: MRS. JULIE MCCUSKER LMT,CSET

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	MA19936	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA19936	OTHER	FL	BOARD OF MASSAGE

General Provider Information

NPI Number	:	1205011533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE MCCUSKER LMT,CSET

Provider Business Mailing Address
First Line	:	8130 US 1
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967-5652
Country	:	US
Telephone Number	:	772-559-9459
Fax Number	:	772-589-0316

Provider Business Practice Location Address
First Line	:	8130 US 1
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967-5652
Country	:	US
Telephone Number	:	772-559-9459
Fax Number	:	772-589-0316

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

Provider Enumeration Date	:	01/06/2008
Last Update Date	:	01/06/2008

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