MEDICARE: SEAN LEONARD MASSA PT

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	225100000X	Physical Therapist	2001007512	MO

General Provider Information

NPI Number	:	1386715118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN LEONARD MASSA PT

Provider Business Mailing Address
First Line	:	300 N MORLEY ST STE I
Second Line	:
City	:	MOBERLY
State	:	MO
Zip	:	65270-2334
Country	:	US
Telephone Number	:	660-263-6223
Fax Number	:	660-263-6224

Provider Business Practice Location Address
First Line	:	300 N MORLEY ST STE I
Second Line	:
City	:	MOBERLY
State	:	MO
Zip	:	65270-2334
Country	:	US
Telephone Number	:	660-263-6223
Fax Number	:	660-263-6224

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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Directions to “ SEAN LEONARD MASSA PT” Practice Location

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