MEDICARE: ALEX ROBERT SPASSOFF 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	MA2936	FL

General Provider Information

NPI Number	:	1720420821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX ROBERT SPASSOFF LMT

Provider Business Mailing Address
First Line	:	307 N HOWARD AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1508
Country	:	US
Telephone Number	:	813-259-3404
Fax Number	:	813-434-1284

Provider Business Practice Location Address
First Line	:	307 N HOWARD AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1508
Country	:	US
Telephone Number	:	813-259-3404
Fax Number	:	813-434-1284

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

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	07/18/2013

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