MEDICARE: MS. GINA MARIE FERRELL 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	174400000X	Specialist	MA33526	FL

General Provider Information

NPI Number	:	1770769010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GINA MARIE FERRELL LMT

Provider Business Mailing Address
First Line	:	3405 NATIVE DANCER TRAIL
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309
Country	:	US
Telephone Number	:	850-222-9876
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 KILLEARN CENTER BLVD
Second Line	:	SUITE A5
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-3467
Country	:	US
Telephone Number	:	850-222-9876
Fax Number	:

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

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	01/17/2008

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