MEDICARE: MS. RENU INDIRA PODUVAL 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	MA76047	FL

General Provider Information

NPI Number	:	1316270689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENU INDIRA PODUVAL LMT

Provider Business Mailing Address
First Line	:	10458 SW 64TH CT
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34476-9361
Country	:	US
Telephone Number	:	352-843-4278
Fax Number	:

Provider Business Practice Location Address
First Line	:	7651 SW STATE ROAD 200
Second Line	:	SUITE 206
City	:	OCALA
State	:	FL
Zip	:	34476-7726
Country	:	US
Telephone Number	:	352-843-4278
Fax Number	:

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

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	06/09/2014

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