MEDICARE: MR. JOSHUA MACLEOD L.M.T.

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-30032	FL

General Provider Information

NPI Number	:	1992931463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSHUA MACLEOD L.M.T.

Provider Business Mailing Address
First Line	:	3577 LAKE EMMA RD
Second Line	:	109
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2056
Country	:	US
Telephone Number	:	407-936-0314
Fax Number	:	407-936-0315

Provider Business Practice Location Address
First Line	:	3577 LAKE EMMA RD
Second Line	:	109
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2056
Country	:	US
Telephone Number	:	407-936-0314
Fax Number	:	407-936-0315

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

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	06/10/2009

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