MEDICARE: JENNIFER A MCDANIEL 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	MA38198	FL

General Provider Information

NPI Number	:	1710268107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER A MCDANIEL LMT

Provider Business Mailing Address
First Line	:	15309 SUN DANCE LN
Second Line	:
City	:	YOUNGSTOWN
State	:	FL
Zip	:	32466-1846
Country	:	US
Telephone Number	:	850-625-5640
Fax Number	:

Provider Business Practice Location Address
First Line	:	15309 SUN DANCE LN
Second Line	:
City	:	YOUNGSTOWN
State	:	FL
Zip	:	32466-1846
Country	:	US
Telephone Number	:	850-625-5640
Fax Number	:

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

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	08/30/2011

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