MEDICARE: MASSOTHERAPY REHABILITATION CLINIC INC.

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	171100000X	Acupuncturist	65.000093	OH

General Provider Information

NPI Number	:	1164691002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASSOTHERAPY REHABILITATION CLINIC INC.

Provider Business Mailing Address
First Line	:	5 SEVERANCE CIR
Second Line	:	SUITE 503
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-1566
Country	:	US
Telephone Number	:	216-381-9995
Fax Number	:	440-551-8179

Provider Business Practice Location Address
First Line	:	5 SEVERANCE CIR
Second Line	:	SUITE 503
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-1566
Country	:	US
Telephone Number	:	216-381-9995
Fax Number	:	440-551-8179

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LEONARD MELAMED
Credential	:	RAC.,LMT,CHT
Telephone Number	:	216-381-9995

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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