MEDICARE: KAREN DAVILA 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	MA 47236	FL

General Provider Information

NPI Number	:	1760676837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN DAVILA LMT

Provider Business Mailing Address
First Line	:	1054 OLD FIELD DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-6252
Country	:	US
Telephone Number	:	813-506-3397
Fax Number	:

Provider Business Practice Location Address
First Line	:	3303 W COLUMBUS DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-1819
Country	:	US
Telephone Number	:	813-876-4514
Fax Number	:

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

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	08/31/2007

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