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NPI Code Detail

MEDICARE: MS. TIFFANY GOMES RODRIGUES LMT, MMP

MEDICARE:  MS. TIFFANY GOMES RODRIGUES  LMT, MMP
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 Therapist55516FL

General Provider Information

NPI Number : 1881981694
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TIFFANY GOMES RODRIGUES LMT, MMP
Provider Business Mailing Address
First Line : 424 ONTARIO ST NW
Second Line :
City : PALM BAY
State : FL
Zip : 32907-1851
Country : US
Telephone Number : 321-431-7725
Fax Number :
Provider Business Practice Location Address
First Line : 424 ONTARIO ST NW
Second Line :
City : PALM BAY
State : FL
Zip : 32907-1851
Country : US
Telephone Number : 321-431-7725
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2011
Last Update Date : 06/30/2011

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Directions to “ MS. TIFFANY GOMES RODRIGUES LMT, MMP” Practice Location

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