MEDICARE: MONTICELLO GARDENS LLC

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

General Provider Information

NPI Number	:	1538018288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTICELLO GARDENS LLC

Provider Business Mailing Address
First Line	:	260 N CHERRY ST
Second Line	:
City	:	MONTICELLO
State	:	FL
Zip	:	32344-1925
Country	:	US
Telephone Number	:	850-320-1122
Fax Number	:	850-360-8008

Provider Business Practice Location Address
First Line	:	260 N CHERRY ST
Second Line	:
City	:	MONTICELLO
State	:	FL
Zip	:	32344-1925
Country	:	US
Telephone Number	:	850-320-1122
Fax Number	:	850-360-8008

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CHANTAL CALAIS-WAFFLER
Credential	:
Telephone Number	:	850-320-1122

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “MONTICELLO GARDENS LLC ” Practice Location

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