MEDICARE: HEART AND SOUL MASSAGE THERAPY

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	MM13170	FL

General Provider Information

NPI Number	:	1821281999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART AND SOUL MASSAGE THERAPY

Provider Business Mailing Address
First Line	:	1435 SE 8TH TER STE D
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3289
Country	:	US
Telephone Number	:	239-573-4325
Fax Number	:	239-573-4327

Provider Business Practice Location Address
First Line	:	1435 SE 8TH TER STE D
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3289
Country	:	US
Telephone Number	:	239-573-4325
Fax Number	:	239-573-4327

Authorized Official
Title or Position	:	OWNER
Name	:	PATRICIA MARIE WEISER
Credential	:
Telephone Number	:	239-573-4325

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/22/2007

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Directions to “HEART AND SOUL MASSAGE THERAPY ” Practice Location

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