MEDICARE: MATTHEW DICONTI CMT

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	38895	CA

General Provider Information

NPI Number	:	1184964298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW DICONTI CMT

Provider Business Mailing Address
First Line	:	99 LONG CT
Second Line	:	SUITE 103
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-6066
Country	:	US
Telephone Number	:	805-558-4241
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 LONG CT
Second Line	:	SUITE 103
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-6066
Country	:	US
Telephone Number	:	805-558-4241
Fax Number	:

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

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	02/26/2013

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