MEDICARE: MR. CRAIG MICHAEL SIMONE 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	0013710	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0013710	OTHER	FL	MASSAGE THERAPY LICENSE

General Provider Information

NPI Number	:	1528210184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG MICHAEL SIMONE LMT

Provider Business Mailing Address
First Line	:	2462 BLACKBURN CIR
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-3140
Country	:	US
Telephone Number	:	239-283-9260
Fax Number	:

Provider Business Practice Location Address
First Line	:	4422 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7439
Country	:	US
Telephone Number	:	239-945-6689
Fax Number	:

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

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	10/15/2008

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