MEDICARE: JASMINE MORRELL 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	MA64096	FL

General Provider Information

NPI Number	:	1639643430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE MORRELL LMT

Provider Business Mailing Address
First Line	:	1052 W STATE ROAD 436 STE 1070
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2939
Country	:	US
Telephone Number	:	407-951-8921
Fax Number	:

Provider Business Practice Location Address
First Line	:	1052 W STATE ROAD 436 STE 1070
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2939
Country	:	US
Telephone Number	:	407-951-8921
Fax Number	:

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

Provider Enumeration Date	:	01/15/2019
Last Update Date	:	01/15/2019

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