MEDICARE: LAURA TOMS 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	11784	SC

General Provider Information

NPI Number	:	1114560158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA TOMS LMT

Provider Business Mailing Address
First Line	:	5715 ROBINSON ST
Second Line	:
City	:	HANAHAN
State	:	SC
Zip	:	29410-3144
Country	:	US
Telephone Number	:	301-473-0239
Fax Number	:

Provider Business Practice Location Address
First Line	:	5529 N RHETT AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-3507
Country	:	US
Telephone Number	:	843-256-3448
Fax Number	:

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

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	10/22/2019

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