MEDICARE: REBECCA CARSON 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	MA34787	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C1723	OTHER	FL	BLUE CROSS PROVIDER

General Provider Information

NPI Number	:	1750454575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA CARSON LMT

Provider Business Mailing Address
First Line	:	1115 MISSISSIPPI AVE
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-2745
Country	:	US
Telephone Number	:	850-624-2353
Fax Number	:

Provider Business Practice Location Address
First Line	:	11212 FRONT BEACH RD
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-3668
Country	:	US
Telephone Number	:	850-624-2353
Fax Number	:

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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