MEDICARE: FAWN BENTON 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	MA78923	FL

General Provider Information

NPI Number	:	1467390237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAWN BENTON LMT

Provider Business Mailing Address
First Line	:	8317 FRONT BEACH RD STE 15
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-4804
Country	:	US
Telephone Number	:	850-832-9273
Fax Number	:

Provider Business Practice Location Address
First Line	:	8317 FRONT BEACH RD STE 15
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-4804
Country	:	US
Telephone Number	:	850-832-9273
Fax Number	:

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

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ FAWN BENTON LMT” Practice Location

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