MEDICARE: MRS. KRISTIN LEAH CHURCHILL 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 63999	FL

General Provider Information

NPI Number	:	1326307455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN LEAH CHURCHILL LMT

Provider Business Mailing Address
First Line	:	108 EXETER AVE
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-3546
Country	:	US
Telephone Number	:	352-396-4877
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 E NORTH BLVD
Second Line	:	SUITE 2
City	:	LEESBURG
State	:	FL
Zip	:	34748-5393
Country	:	US
Telephone Number	:	352-396-4877
Fax Number	:

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

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	01/13/2016

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