MEDICARE: MS. DARLENE JANE KROLL LMT, EMT, RMA

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	MA41235	FL

General Provider Information

NPI Number	:	1801852918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DARLENE JANE KROLL LMT, EMT, RMA

Provider Business Mailing Address
First Line	:	1771 GULFSTREAM AVE
Second Line	:	C4
City	:	FORT PIERCE
State	:	FL
Zip	:	34949-3517
Country	:	US
Telephone Number	:	772-461-4004
Fax Number	:	772-461-2242

Provider Business Practice Location Address
First Line	:	1771 GULFSTREAM AVE
Second Line	:	C4
City	:	FORT PIERCE
State	:	FL
Zip	:	34949-3517
Country	:	US
Telephone Number	:	772-461-4004
Fax Number	:	772-461-2242

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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