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NPI Code Detail

MEDICARE: CASSIE DEANNA HARRIS L.M.T.

MEDICARE:   CASSIE DEANNA HARRIS  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
1225700000XMassage TherapistMA58954FL

General Provider Information

NPI Number : 1649598541
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIE DEANNA HARRIS L.M.T.
Provider Business Mailing Address
First Line : 17684 129TH RD
Second Line :
City : MC ALPIN
State : FL
Zip : 32062-2418
Country : US
Telephone Number : 386-209-4977
Fax Number :
Provider Business Practice Location Address
First Line : 17684 129TH RD
Second Line :
City : MC ALPIN
State : FL
Zip : 32062-2418
Country : US
Telephone Number : 386-209-4977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2010
Last Update Date : 05/19/2010

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