MEDICARE: MR. DONALD JOSEPH DEWIT II MASSAGE THERAPIST

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	MA104586	FL

General Provider Information

NPI Number	:	1487498200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD JOSEPH DEWIT II MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	6850 13TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-5318
Country	:	US
Telephone Number	:	816-786-9942
Fax Number	:

Provider Business Practice Location Address
First Line	:	6850 13TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-5318
Country	:	US
Telephone Number	:	816-786-9942
Fax Number	:

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

Provider Enumeration Date	:	06/25/2024
Last Update Date	:	06/25/2024

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