MEDICARE: LEILA EL MOHAMED MASSAGE THERAPIST

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

General Provider Information

NPI Number	:	1184302945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEILA EL MOHAMED MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	1849 PASEO SAN LUIS
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-4613
Country	:	US
Telephone Number	:	520-458-1577
Fax Number	:	520-458-1580

Provider Business Practice Location Address
First Line	:	1849 PASEO SAN LUIS
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-4613
Country	:	US
Telephone Number	:	520-458-1577
Fax Number	:	520-458-1580

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

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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