MEDICARE: MR. BENSON TONG

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	MA83516	FL

General Provider Information

NPI Number	:	1679173538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENSON TONG

Provider Business Mailing Address
First Line	:	1729 21ST AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33713-5037
Country	:	US
Telephone Number	:	202-468-6595
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 1ST AVE N STE 206
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33713-8442
Country	:	US
Telephone Number	:	202-468-6595
Fax Number	:

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

Provider Enumeration Date	:	10/29/2020
Last Update Date	:	10/29/2020

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