MEDICARE: MS. CORINNE LAROCCO 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	MA 45270	FL

General Provider Information

NPI Number	:	1285814749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CORINNE LAROCCO LMT

Provider Business Mailing Address
First Line	:	10065 EMERALD COAST PKWY W
Second Line	:	SUITE 101 A
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-4924
Country	:	US
Telephone Number	:	850-650-0060
Fax Number	:	850-650-8130

Provider Business Practice Location Address
First Line	:	10065 EMERALD COAST PKWY W
Second Line	:	SUITE 101 A
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-4924
Country	:	US
Telephone Number	:	850-650-0060
Fax Number	:	850-650-8130

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

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	11/13/2007

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