MEDICARE: MR. DAVID PAUL MAILE 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	MA12693	FL

General Provider Information

NPI Number	:	1689013302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID PAUL MAILE LMT

Provider Business Mailing Address
First Line	:	12601 LAS OLAS LN
Second Line	:	UNIT 124
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3378
Country	:	US
Telephone Number	:	239-823-6481
Fax Number	:

Provider Business Practice Location Address
First Line	:	6710 WINKLER RD
Second Line	:	STE 2
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7274
Country	:	US
Telephone Number	:	239-823-6481
Fax Number	:

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

Provider Enumeration Date	:	06/15/2013
Last Update Date	:	08/06/2013

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