MEDICARE: MARILYN GERARDO

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	MA 57742	FL

General Provider Information

NPI Number	:	1508195819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN GERARDO

Provider Business Mailing Address
First Line	:	1235 MORGAN DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-2931
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 MORGAN DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-2931
Country	:	US
Telephone Number	:	813-610-5449
Fax Number	:

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

Provider Enumeration Date	:	12/15/2009
Last Update Date	:	12/15/2009

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Directions to “ MARILYN GERARDO ” Practice Location

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