MEDICARE: MR. DON C METTE LMT,MTPT,SET

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	MA20212	FL

General Provider Information

NPI Number	:	1710174768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DON C METTE LMT,MTPT,SET

Provider Business Mailing Address
First Line	:	2144 HOLLY OAKS RIVER DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-4885
Country	:	US
Telephone Number	:	904-655-4965
Fax Number	:

Provider Business Practice Location Address
First Line	:	2144 HOLLY OAKS RIVER DR
Second Line	:	MOBILE PRACTICE
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225
Country	:	US
Telephone Number	:	904-655-4965
Fax Number	:

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

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	10/03/2007

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