MEDICARE: MR. DEVIN S HEALY M.ED., ATC/L

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	174400000X	Specialist

General Provider Information

NPI Number	:	1578558995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEVIN S HEALY M.ED., ATC/L

Provider Business Mailing Address
First Line	:	5150 LONG LAKE CIR
Second Line	:	APT 107
City	:	LAKELAND
State	:	FL
Zip	:	33805-9604
Country	:	US
Telephone Number	:	863-370-1809
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 LONG LAKE CIR
Second Line	:	APT 107
City	:	LAKELAND
State	:	FL
Zip	:	33805-9604
Country	:	US
Telephone Number	:	863-370-1809
Fax Number	:

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	01/11/2013

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