MEDICARE: MR. JORGE LUIS SOTOMAYOR MA

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	MA 66681	FL

General Provider Information

NPI Number	:	1679844724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JORGE LUIS SOTOMAYOR MA

Provider Business Mailing Address
First Line	:	3210 W COLUMBUS DR
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33607-1816
Country	:	US
Telephone Number	:	813-443-0588
Fax Number	:	813-443-4722

Provider Business Practice Location Address
First Line	:	3210 W COLUMBUS DR
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33607-1816
Country	:	US
Telephone Number	:	813-443-0588
Fax Number	:	813-443-4722

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

Provider Enumeration Date	:	01/21/2012
Last Update Date	:	01/21/2012

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