MEDICARE: BEYOND MASSAGE, LLC

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

General Provider Information

NPI Number	:	1255706206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEYOND MASSAGE, LLC

Provider Business Mailing Address
First Line	:	1313 LYNDON LN
Second Line	:	#101
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7351
Country	:	US
Telephone Number	:	502-741-8963
Fax Number	:	502-650-8271

Provider Business Practice Location Address
First Line	:	1313 LYNDON LN
Second Line	:	#101
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7351
Country	:	US
Telephone Number	:	502-741-8963
Fax Number	:	502-650-8271

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH GEHRKE FOY
Credential	:	LMT
Telephone Number	:	502-741-8963

Provider Enumeration Date	:	12/02/2015
Last Update Date	:	12/02/2015

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Directions to “BEYOND MASSAGE, LLC ” Practice Location

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