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NPI Code Detail

MEDICARE: KELLY MAZZARELLA LMT

MEDICARE:   KELLY  MAZZARELLA  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
1225700000XMassage TherapistMA74384FL

General Provider Information

NPI Number : 1841948510
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MAZZARELLA LMT
Provider Business Mailing Address
First Line : 10443 SPRING LAKE DR
Second Line :
City : CLERMONT
State : FL
Zip : 34711-7929
Country : US
Telephone Number : 407-633-1565
Fax Number :
Provider Business Practice Location Address
First Line : 10443 SPRING LAKE DR
Second Line :
City : CLERMONT
State : FL
Zip : 34711-7929
Country : US
Telephone Number : 407-633-1565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2022
Last Update Date : 03/12/2022

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Directions to “ KELLY MAZZARELLA LMT” Practice Location

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