MEDICARE: MR. JESUS DELA COURET 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	MA26430	FL

General Provider Information

NPI Number	:	1497071104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JESUS DELA COURET LMT

Provider Business Mailing Address
First Line	:	1395 W SUNRISE BLVD
Second Line	:	STE 1
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33311-7076
Country	:	US
Telephone Number	:	954-616-5849
Fax Number	:	954-616-5851

Provider Business Practice Location Address
First Line	:	1395 W SUNRISE BLVD
Second Line	:	STE 1
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33311-7076
Country	:	US
Telephone Number	:	954-616-5849
Fax Number	:	954-616-5851

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

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	04/20/2010

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