MEDICARE: PATRICIA LEON 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	MA0027504	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C2653	OTHER	FL	BLUE CROSS

General Provider Information

NPI Number	:	1538312392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA LEON LMT

Provider Business Mailing Address
First Line	:	PO BOX 49583
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34230-6583
Country	:	US
Telephone Number	:	941-321-6917
Fax Number	:	941-366-6075

Provider Business Practice Location Address
First Line	:	810 CENTRAL AVE
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-4021
Country	:	US
Telephone Number	:	941-321-6917
Fax Number	:	941-366-6075

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

Provider Enumeration Date	:	10/24/2008
Last Update Date	:	10/24/2008

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