MEDICARE: MS. SUIRA GOMEZ 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	48277	FL
2	172M00000X	Mechanotherapist	MA48277	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA48277	OTHER	FL	MA 48277

General Provider Information

NPI Number	:	1932842069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUIRA GOMEZ LMT

Provider Business Mailing Address
First Line	:	9632 GROVE HILL LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-1556
Country	:	US
Telephone Number	:	954-512-0826
Fax Number	:

Provider Business Practice Location Address
First Line	:	9785 CROSSHILL BLVD # 108
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-5823
Country	:	US
Telephone Number	:	904-772-6522
Fax Number	:

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

Provider Enumeration Date	:	04/17/2022
Last Update Date	:	02/21/2023

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