MEDICARE: MR. MICHAEL LEON GARCIA R.N., 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	MA21545	FL

General Provider Information

NPI Number	:	1639193436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL LEON GARCIA R.N., L.M.T.

Provider Business Mailing Address
First Line	:	7023 SHADY PINE ST W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-4537
Country	:	US
Telephone Number	:	904-778-2433
Fax Number	:

Provider Business Practice Location Address
First Line	:	4642 SAN JUAN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3228
Country	:	US
Telephone Number	:	904-389-9117
Fax Number	:

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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