MEDICARE: HARRY WARANCH 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	172M00000X	Mechanotherapist	MA23744	FL

General Provider Information

NPI Number	:	1215258439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRY WARANCH L.M.T.

Provider Business Mailing Address
First Line	:	2225 A1A S STE B1
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080-7906
Country	:	US
Telephone Number	:	904-461-9901
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 A1A S STE B1
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080-7906
Country	:	US
Telephone Number	:	904-461-9901
Fax Number	:

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

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	06/22/2010

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