MEDICARE: MISS MARY JO MAUK B.S.,RRT

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	227900000X	Registered Respiratory Therapist	RT 10330	FL

General Provider Information

NPI Number	:	1336478817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARY JO MAUK B.S.,RRT

Provider Business Mailing Address
First Line	:	600 PACES PKWY STE 302
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-4814
Country	:	US
Telephone Number	:	678-492-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4602 NORTH ARMENIA AVE.
Second Line	:	STE. C
City	:	TAMPA
State	:	FL
Zip	:	33603
Country	:	US
Telephone Number	:	813-870-0000
Fax Number	:

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

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	12/14/2009

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