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NPI Code Detail

MEDICARE: REBECCA JILL WHISENANT LMT, CPT

MEDICARE: REBECCA JILL WHISENANT LMT, CPT
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
1225700000XMassage TherapistMA#73337FL

General Provider Information

NPI Number : 1255772455
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA JILL WHISENANT LMT, CPT
Provider Business Mailing Address
First Line : 102 W MORENO ST APT 2
Second Line :
City : PENSACOLA
State : FL
Zip : 32501-2160
Country : US
Telephone Number : 850-736-2526
Fax Number :
Provider Business Practice Location Address
First Line : 730 N NEW WARRINGTON RD
Second Line :
City : PENSACOLA
State : FL
Zip : 32506-4247
Country : US
Telephone Number : 850-466-8734
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2013
Last Update Date : 09/27/2013

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