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NPI Code Detail

MEDICARE: ROMAN DUTKA L.M.T.

MEDICARE: ROMAN DUTKA 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
1225700000XMassage Therapist33.019261OH

General Provider Information

NPI Number : 1144505033
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROMAN DUTKA L.M.T.
Provider Business Mailing Address
First Line : 7155 PEARL RD
Second Line : SUITE 104
City : CLEVELAND
State : OH
Zip : 44130-4945
Country : US
Telephone Number : 216-264-3999
Fax Number : 216-772-7467
Provider Business Practice Location Address
First Line : 7155 PEARL RD
Second Line : SUITE 104
City : CLEVELAND
State : OH
Zip : 44130-4945
Country : US
Telephone Number : 216-264-3999
Fax Number : 216-772-7467
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2011
Last Update Date : 10/11/2011

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