MEDICARE: BETHANY LILLY LMT

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	MT-22215	AZ

General Provider Information

NPI Number	:	1427556430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY LILLY LMT

Provider Business Mailing Address
First Line	:	2930 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1912
Country	:	US
Telephone Number	:	520-320-1953
Fax Number	:

Provider Business Practice Location Address
First Line	:	2930 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1912
Country	:	US
Telephone Number	:	520-320-1953
Fax Number	:

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

Provider Enumeration Date	:	01/24/2018
Last Update Date	:	01/24/2018

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Directions to “ BETHANY LILLY LMT” Practice Location

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