MEDICARE: GREGG ROBERT BROMBERG 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	MA88867	FL

General Provider Information

NPI Number	:	1487110276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGG ROBERT BROMBERG LMT

Provider Business Mailing Address
First Line	:	3900 GALT OCEAN DR APT 2015
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6611
Country	:	US
Telephone Number	:	917-648-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 GALT OCEAN DR APT 2015
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6611
Country	:	US
Telephone Number	:	917-648-1600
Fax Number	:

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

Provider Enumeration Date	:	02/16/2019
Last Update Date	:	02/16/2019

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