MEDICARE: SOPHIE MT MAURICE 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	MA44572	FL

General Provider Information

NPI Number	:	1558692921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIE MT MAURICE LMT

Provider Business Mailing Address
First Line	:	5760 BAYWATER DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3525
Country	:	US
Telephone Number	:	727-482-3865
Fax Number	:

Provider Business Practice Location Address
First Line	:	6911 PISTOL RANGE RD
Second Line	:	103-A
City	:	TAMPA
State	:	FL
Zip	:	33635-6335
Country	:	US
Telephone Number	:	727-482-3865
Fax Number	:

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

Provider Enumeration Date	:	01/24/2010
Last Update Date	:	11/18/2012

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Directions to “ SOPHIE MT MAURICE LMT” Practice Location

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