MEDICARE: TOD ALAN TAYLOR LMP

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	0021700	WA

General Provider Information

NPI Number	:	1184941882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOD ALAN TAYLOR LMP

Provider Business Mailing Address
First Line	:	5625 16TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-1459
Country	:	US
Telephone Number	:	206-852-0139
Fax Number	:

Provider Business Practice Location Address
First Line	:	5625 16TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-1459
Country	:	US
Telephone Number	:	206-852-0139
Fax Number	:

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

Provider Enumeration Date	:	04/21/2010
Last Update Date	:	04/21/2010

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Directions to “ TOD ALAN TAYLOR LMP” Practice Location

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