MEDICARE: MR. CHRISTOPHER THOMAS CLARKE 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	MA37417	FL

General Provider Information

NPI Number	:	1548401557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER THOMAS CLARKE LMT

Provider Business Mailing Address
First Line	:	31956 US 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3730
Country	:	US
Telephone Number	:	727-364-1921
Fax Number	:

Provider Business Practice Location Address
First Line	:	31956 US 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3730
Country	:	US
Telephone Number	:	727-364-1921
Fax Number	:

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

Provider Enumeration Date	:	03/20/2009
Last Update Date	:	03/20/2009

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