MEDICARE: MRS. LINDSEY MARIE COLLINSON-RANKIN 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	225700000X	Massage Therapist	MA84564	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA84564	OTHER	FL	MASSAGE LICENSE NUMBER

General Provider Information

NPI Number	:	1821865866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDSEY MARIE COLLINSON-RANKIN LMT

Provider Business Mailing Address
First Line	:	3510 S NOVA RD STE 108
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-3796
Country	:	US
Telephone Number	:	321-313-8748
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 S NOVA RD STE 108
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-3796
Country	:	US
Telephone Number	:	321-313-8748
Fax Number	:

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

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/13/2023

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