MEDICARE: MR. TEOFIL FLOROV NIKOLOV 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	MA28362	FL

General Provider Information

NPI Number	:	1548454358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TEOFIL FLOROV NIKOLOV LMT

Provider Business Mailing Address
First Line	:	PO BOX 9677
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34101-9677
Country	:	US
Telephone Number	:	239-450-4325
Fax Number	:

Provider Business Practice Location Address
First Line	:	2681 AIRPORT RD S
Second Line	:	SUITE C 110
City	:	NAPLES
State	:	FL
Zip	:	34112-4809
Country	:	US
Telephone Number	:	239-450-4325
Fax Number	:

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

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	08/15/2010

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