MEDICARE: ATLANTIC STRUCTURAL ENERGETIC THERAPY, INC.

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	MA20212	FL

General Provider Information

NPI Number	:	1780992974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC STRUCTURAL ENERGETIC THERAPY, INC.

Provider Business Mailing Address
First Line	:	2144 HOLLY OAKS RIVER DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-4885
Country	:	US
Telephone Number	:	904-655-4965
Fax Number	:

Provider Business Practice Location Address
First Line	:	2144 HOLLY OAKS RIVER DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-4885
Country	:	US
Telephone Number	:	904-655-4965
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DON C METTE'
Credential	:	LMT,MTPT,SET
Telephone Number	:	904-455-6955

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	09/22/2010

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