MEDICARE: DAWN G MCCREARY 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	MA47324	FL

General Provider Information

NPI Number	:	1760706865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN G MCCREARY LMT

Provider Business Mailing Address
First Line	:	5943 CALAIS BLVD N
Second Line	:	UNIT 4
City	:	ST PETERSBURG
State	:	FL
Zip	:	33714-4769
Country	:	US
Telephone Number	:	727-403-9307
Fax Number	:

Provider Business Practice Location Address
First Line	:	3330 DR MARTIN LUTHER KING JR ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-1212
Country	:	US
Telephone Number	:	727-403-9307
Fax Number	:

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

Provider Enumeration Date	:	03/17/2010
Last Update Date	:	03/17/2010

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