MEDICARE: MISS MARY ELIZABETH MARTON 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	173C00000X	Reflexologist
2	225700000X	Massage Therapist	MA57280	FL

General Provider Information

NPI Number	:	1164748364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARY ELIZABETH MARTON L.M.T.

Provider Business Mailing Address
First Line	:	12302 N 27TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-4707
Country	:	US
Telephone Number	:	813-833-7594
Fax Number	:	813-569-4839

Provider Business Practice Location Address
First Line	:	12302 N 27TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-4707
Country	:	US
Telephone Number	:	813-569-4839
Fax Number	:	813-569-4839

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

Provider Enumeration Date	:	04/13/2010
Last Update Date	:	04/13/2010

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