MEDICARE: RUBY LEE MCDONALD

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 46323	FL

General Provider Information

NPI Number	:	1255452744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBY LEE MCDONALD

Provider Business Mailing Address
First Line	:	516 GOODWIN AVE
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32169-2702
Country	:	US
Telephone Number	:	386-689-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 GOODWIN AVE
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32169-2702
Country	:	US
Telephone Number	:	386-689-5100
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	08/08/2011

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Directions to “ RUBY LEE MCDONALD ” Practice Location

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