MEDICARE: MR. ELLIOT R SHRATTER CMTPT

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	1651	NM

General Provider Information

NPI Number	:	1235146432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ELLIOT R SHRATTER CMTPT

Provider Business Mailing Address
First Line	:	1916 GRIEGOS RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-2837
Country	:	US
Telephone Number	:	505-344-9269
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 RIO GRANDE NW
Second Line	:	SUITE B
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-2633
Country	:	US
Telephone Number	:	505-265-4943
Fax Number	:	505-265-4986

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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