MEDICARE: ANTHONY FRANK SPADAVECCHIO 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	MA25883	FL

General Provider Information

NPI Number	:	1366627531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY FRANK SPADAVECCHIO L.M.T.

Provider Business Mailing Address
First Line	:	5555 E MICHIGAN ST
Second Line	:	SUITE 102
City	:	ORLANDO
State	:	FL
Zip	:	32822-2700
Country	:	US
Telephone Number	:	407-275-9334
Fax Number	:	407-275-9395

Provider Business Practice Location Address
First Line	:	5555 E MICHIGAN ST
Second Line	:	SUITE 102
City	:	ORLANDO
State	:	FL
Zip	:	32822-2700
Country	:	US
Telephone Number	:	407-275-9334
Fax Number	:	407-275-9395

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

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/07/2008

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