MEDICARE: SARA DOROTHY WEGSCHEID 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	MA91312	FL

General Provider Information

NPI Number	:	1487241154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA DOROTHY WEGSCHEID LMT

Provider Business Mailing Address
First Line	:	1394 NE 808TH ST
Second Line	:
City	:	OLD TOWN
State	:	FL
Zip	:	32680-8291
Country	:	US
Telephone Number	:	954-871-4208
Fax Number	:

Provider Business Practice Location Address
First Line	:	26638 SE HWY 19 UNIT B
Second Line	:
City	:	OLD TOWN
State	:	FL
Zip	:	32680-8539
Country	:	US
Telephone Number	:	954-871-4208
Fax Number	:

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

Provider Enumeration Date	:	12/28/2020
Last Update Date	:	12/28/2020

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