MEDICARE: MR. SAMUEL P EASLEY 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	MA30459	FL

General Provider Information

NPI Number	:	1700105368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL P EASLEY LMT

Provider Business Mailing Address
First Line	:	2314 MIDTOWN TER APT 1133
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-4530
Country	:	US
Telephone Number	:	407-463-6552
Fax Number	:

Provider Business Practice Location Address
First Line	:	2314 MIDTOWN TER APT 1133
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-4530
Country	:	US
Telephone Number	:	407-463-6552
Fax Number	:

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

Provider Enumeration Date	:	05/21/2010
Last Update Date	:	05/21/2010

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Directions to “ MR. SAMUEL P EASLEY LMT” Practice Location

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