MEDICARE: MISS MARY PAT VASSAR CMT,CRT

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	172M00000X	Mechanotherapist
2	173C00000X	Reflexologist

General Provider Information

NPI Number	:	1205075884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARY PAT VASSAR CMT,CRT

Provider Business Mailing Address
First Line	:	2515 COUNTY ROAD 90
Second Line	:
City	:	MAPLE PLAIN
State	:	MN
Zip	:	55359-9764
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 COUNTY ROAD 90
Second Line	:
City	:	MAPLE PLAIN
State	:	MN
Zip	:	55359-9764
Country	:	US
Telephone Number	:	763-479-2677
Fax Number	:

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

Provider Enumeration Date	:	02/05/2009
Last Update Date	:	02/05/2009

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