MEDICARE: DEBORAH BRUGH WEMPLE L.M.T.

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	MA7990	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	C5173	OTHER	FL	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1346361862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH BRUGH WEMPLE L.M.T.

Provider Business Mailing Address
First Line	:	PO BOX 645
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32170-0645
Country	:	US
Telephone Number	:	386-428-0723
Fax Number	:	386-428-0723

Provider Business Practice Location Address
First Line	:	120 FAULKNER ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7018
Country	:	US
Telephone Number	:	386-428-0723
Fax Number	:	386-428-0723

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	11/11/2010

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