MEDICARE: SUNCOAST MASSAGE THERAPY CENTER, P.A.

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	261Q00000X	Clinic/Center	MM7492	FL

General Provider Information

NPI Number	:	1992712509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCOAST MASSAGE THERAPY CENTER, P.A.

Provider Business Mailing Address
First Line	:	307 N HOWARD AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1508
Country	:	US
Telephone Number	:	813-259-3404
Fax Number	:	813-259-9823

Provider Business Practice Location Address
First Line	:	307 N HOWARD AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1508
Country	:	US
Telephone Number	:	813-259-3404
Fax Number	:	813-259-9823

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALEX R SPASSOFF
Credential	:	LMT
Telephone Number	:	813-259-3404

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	08/22/2020

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