MEDICARE: MARIA SELLARS L.M.T.

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	MA53478	FL

General Provider Information

NPI Number	:	1790910602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA SELLARS L.M.T.

Provider Business Mailing Address
First Line	:	514 NANTUCKET CT
Second Line	:	#302
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2194
Country	:	US
Telephone Number	:	407-506-5215
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 E ALTAMONTE DR
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4338
Country	:	US
Telephone Number	:	407-506-5215
Fax Number	:

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

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	05/20/2009

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