MEDICARE: CHARLENE LUTE 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	86692	FL

General Provider Information

NPI Number	:	1649938085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE LUTE LMT

Provider Business Mailing Address
First Line	:	3861 ELDRIDGE AVE
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-2154
Country	:	US
Telephone Number	:	361-443-0279
Fax Number	:

Provider Business Practice Location Address
First Line	:	1526 UNIVERSITY BLVD W # LOFT12
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2006
Country	:	US
Telephone Number	:	361-443-0278
Fax Number	:

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

Provider Enumeration Date	:	12/02/2021
Last Update Date	:	12/02/2021

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Directions to “ CHARLENE LUTE LMT” Practice Location

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