MEDICARE: KANDY T LOVE MASSAGE THERAPIST

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	MA9704	FL

General Provider Information

NPI Number	:	1639486871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANDY T LOVE MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	15951 MC GREGOR BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-0000
Country	:	US
Telephone Number	:	239-433-5995
Fax Number	:

Provider Business Practice Location Address
First Line	:	15951 MCGREGOR BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-2552
Country	:	US
Telephone Number	:	239-433-5995
Fax Number	:

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

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	09/09/2010

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