MEDICARE: MRS. REGINA MATTHEWS

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	MT20901107	IN

General Provider Information

NPI Number	:	1447577747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REGINA MATTHEWS

Provider Business Mailing Address
First Line	:	6335 WATERSTONE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-4882
Country	:	US
Telephone Number	:	317-641-4835
Fax Number	:	317-663-2963

Provider Business Practice Location Address
First Line	:	6335 WATERSTONE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-4882
Country	:	US
Telephone Number	:	317-641-4835
Fax Number	:	317-663-2963

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

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	04/26/2010

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Directions to “ MRS. REGINA MATTHEWS ” Practice Location

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