MEDICARE: JESSICA M. CROSBY L.M.T.

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	171W00000X	Contractor	MA:24155	FL

General Provider Information

NPI Number	:	1538319439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA M. CROSBY L.M.T.

Provider Business Mailing Address
First Line	:	1725 SW IMPORT DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-2408
Country	:	US
Telephone Number	:	772-215-5278
Fax Number	:	772-878-5455

Provider Business Practice Location Address
First Line	:	690 SE MONTEREY RD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-4410
Country	:	US
Telephone Number	:	772-215-5278
Fax Number	:	772-878-5455

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

Provider Enumeration Date	:	09/26/2008
Last Update Date	:	09/26/2008

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