MEDICARE: LESLIE J SHARP-WOOD 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	MA46534	FL

General Provider Information

NPI Number	:	1619137056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE J SHARP-WOOD L.M.T.

Provider Business Mailing Address
First Line	:	7118 EARLY GOLD LN
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-4317
Country	:	US
Telephone Number	:	813-789-3320
Fax Number	:

Provider Business Practice Location Address
First Line	:	5260 S MACDILL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-4094
Country	:	US
Telephone Number	:	813-789-3320
Fax Number	:

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/10/2008

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