MEDICARE: MRS. JOAN LYNN KANE 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	MA41587	FL

General Provider Information

NPI Number	:	1861710147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOAN LYNN KANE LMT

Provider Business Mailing Address
First Line	:	2167 JULIAN AVE NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4045
Country	:	US
Telephone Number	:	321-220-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2167 JULIAN AVE NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4045
Country	:	US
Telephone Number	:	321-220-2000
Fax Number	:

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

Provider Enumeration Date	:	05/11/2010
Last Update Date	:	05/11/2010

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