MEDICARE: MS. MICHELE S CONNER 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	MA 56878	FL

General Provider Information

NPI Number	:	1881927531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELE S CONNER LMT

Provider Business Mailing Address
First Line	:	2706 W SAINT ISABEL ST STE D&C
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6382
Country	:	US
Telephone Number	:	813-443-5772
Fax Number	:	813-443-5775

Provider Business Practice Location Address
First Line	:	2706 W SAINT ISABEL ST STE D&C
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6382
Country	:	US
Telephone Number	:	813-443-5772
Fax Number	:	813-443-5775

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

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	09/14/2009

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