MEDICARE: BRANDY NICHOLE STONE L.M.T.

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	MA52885	FL

General Provider Information

NPI Number	:	1619125606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY NICHOLE STONE L.M.T.

Provider Business Mailing Address
First Line	:	4924 SLASH PINE TRL
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-3539
Country	:	US
Telephone Number	:	772-519-4613
Fax Number	:

Provider Business Practice Location Address
First Line	:	4924 SLASH PINE TRL
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-3539
Country	:	US
Telephone Number	:	772-519-4613
Fax Number	:

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

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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