MEDICARE: TINA WITHROW 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	33-014250	OH

General Provider Information

NPI Number	:	1518327295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA WITHROW LMT

Provider Business Mailing Address
First Line	:	4885 HAMILTON EATON RD
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-9718
Country	:	US
Telephone Number	:	513-706-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	8106 BECKETT CENTER DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-5015
Country	:	US
Telephone Number	:	513-706-6600
Fax Number	:

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

Provider Enumeration Date	:	02/24/2016
Last Update Date	:	02/24/2016

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