MEDICARE: V R MASSAGE & THERAPY CENTER INC

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	261QH0100X	Health Service Clinic/Center	MM19484	FL

General Provider Information

NPI Number	:	1346443512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	V R MASSAGE & THERAPY CENTER INC

Provider Business Mailing Address
First Line	:	6632 HANLEY RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-4704
Country	:	US
Telephone Number	:	813-884-5390
Fax Number	:	813-885-2958

Provider Business Practice Location Address
First Line	:	6632 HANLEY RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-4704
Country	:	US
Telephone Number	:	813-884-5390
Fax Number	:	813-885-2958

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MRS. IDALMIS MONTANO
Credential	:	MA
Telephone Number	:	813-884-5390

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	08/22/2020

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