MEDICARE: VICTORIA VALIANTE 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	MA95324	FL

General Provider Information

NPI Number	:	1477144707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA VALIANTE LMT

Provider Business Mailing Address
First Line	:	6600 SW 13TH ST APT B
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-5417
Country	:	US
Telephone Number	:	904-631-2508
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 NW 43RD ST STE 3124
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-7546
Country	:	US
Telephone Number	:	352-448-9887
Fax Number	:

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

Provider Enumeration Date	:	01/29/2021
Last Update Date	:	01/29/2021

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