MEDICARE: MR. GEORGY RODRIGUEZ

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	64007	FL

General Provider Information

NPI Number	:	1508122961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGY RODRIGUEZ

Provider Business Mailing Address
First Line	:	4954 PIMLICO CT
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-9116
Country	:	US
Telephone Number	:	786-768-0533
Fax Number	:

Provider Business Practice Location Address
First Line	:	4954 PIMLICO CT
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-9116
Country	:	US
Telephone Number	:	786-768-0533
Fax Number	:

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

Provider Enumeration Date	:	04/10/2012
Last Update Date	:	04/26/2012

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