MEDICARE: MR. OMAR JOEL MALDONADO 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	MA37427	FL

General Provider Information

NPI Number	:	1235367673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OMAR JOEL MALDONADO LMT

Provider Business Mailing Address
First Line	:	1705 E HIGHWAY 50
Second Line	:	SUITE B
City	:	CLERMONT
State	:	FL
Zip	:	34711-5186
Country	:	US
Telephone Number	:	352-394-7577
Fax Number	:	352-394-8000

Provider Business Practice Location Address
First Line	:	1705 E HIGHWAY 50
Second Line	:	SUITE B
City	:	CLERMONT
State	:	FL
Zip	:	34711-5186
Country	:	US
Telephone Number	:	352-394-7577
Fax Number	:	352-394-8000

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

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	06/24/2009

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