MEDICARE: MS. DENISE D BEITEL L.M.T.

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	174400000X	Specialist	MA19045	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C4024	OTHER	FL	BLUE CROSS BLUE SHIELD OF

General Provider Information

NPI Number	:	1235347766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE D BEITEL L.M.T.

Provider Business Mailing Address
First Line	:	460 SAULS ST
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-7561
Country	:	US
Telephone Number	:	386-672-1001
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 S YONGE ST
Second Line	:	STE. A
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-6286
Country	:	US
Telephone Number	:	386-673-0524
Fax Number	:	386-673-0539

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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