MEDICARE: ADVANTAGE WELLCARE

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	MA42601	FL

General Provider Information

NPI Number	:	1972509123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE WELLCARE

Provider Business Mailing Address
First Line	:	3244 TEALWOOD TER
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-3072
Country	:	US
Telephone Number	:	386-846-1419
Fax Number	:

Provider Business Practice Location Address
First Line	:	3244 TEALWOOD TER
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-3072
Country	:	US
Telephone Number	:	386-846-1419
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREA KINNEY
Credential	:	LMT
Telephone Number	:	386-846-1419

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/16/2008

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Directions to “ADVANTAGE WELLCARE ” Practice Location

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