MEDICARE: ROGER GRECO L.M.T. LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760795777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGER GRECO L.M.T. LLC

Provider Business Mailing Address
First Line	:	3218 ANDERSON PL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-6744
Country	:	US
Telephone Number	:	407-712-5280
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 VIRGINIA DR
Second Line	:	SUITE 102
City	:	ORLANDO
State	:	FL
Zip	:	32803-2531
Country	:	US
Telephone Number	:	407-712-5280
Fax Number	:

Authorized Official
Title or Position	:	OPERATING MANAGER AND SECRETARY
Name	:	ROGER GRECO
Credential	:	L.M.T.
Telephone Number	:	407-712-5280

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	06/17/2011

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