MEDICARE: LISA H JAMISON 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	MA42488	FL

General Provider Information

NPI Number	:	1871783688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA H JAMISON LMT

Provider Business Mailing Address
First Line	:	512 WHEATON TRENT PL
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-0812
Country	:	US
Telephone Number	:	727-510-4959
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 W PLATT ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2142
Country	:	US
Telephone Number	:	727-510-4959
Fax Number	:

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

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	07/27/2007

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