MEDICARE: MS. JANET GLADIS 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	MA38026	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C2772	OTHER	FL	BLUE CROSS/ BLUE SHIELD OF FLORIDA

General Provider Information

NPI Number	:	1598990962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANET GLADIS LMT

Provider Business Mailing Address
First Line	:	2300 W 11TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-1632
Country	:	US
Telephone Number	:	850-625-9086
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 W 11TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-1632
Country	:	US
Telephone Number	:	850-625-9086
Fax Number	:

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

Provider Enumeration Date	:	05/28/2009
Last Update Date	:	05/28/2009

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