MEDICARE: SUNRISE MASSAGE THERAPY SERVICES

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	174400000X	Specialist	15392	OH

General Provider Information

NPI Number	:	1154692085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE MASSAGE THERAPY SERVICES

Provider Business Mailing Address
First Line	:	260 KENT AVE NE
Second Line	:
City	:	HARTVILLE
State	:	OH
Zip	:	44632-9695
Country	:	US
Telephone Number	:	330-877-2729
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 KENT AVE NE
Second Line	:
City	:	HARTVILLE
State	:	OH
Zip	:	44632-9695
Country	:	US
Telephone Number	:	330-877-2729
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TINA MARIE READ
Credential	:	LMT
Telephone Number	:	330-877-2729

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	01/24/2012

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