MEDICARE: BETHANY DEROSA 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	104844	FL

General Provider Information

NPI Number	:	1730076753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY DEROSA LMT

Provider Business Mailing Address
First Line	:	5255 OLIVET DR
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33523-9039
Country	:	US
Telephone Number	:	352-737-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	5255 OLIVET DR
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33523-9039
Country	:	US
Telephone Number	:	352-737-8888
Fax Number	:

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

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	06/23/2025

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Directions to “ BETHANY DEROSA LMT” Practice Location

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