MEDICARE: MELISSA MACDONALD LMT, CPT, RYT

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	MA96342	FL
2	225700000X	Massage Therapist	18KT01328800	NJ

General Provider Information

NPI Number	:	1538742507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MACDONALD LMT, CPT, RYT

Provider Business Mailing Address
First Line	:	41 PILGRIM PATHWAY APT 8
Second Line	:
City	:	OCEAN GROVE
State	:	NJ
Zip	:	07756-1551
Country	:	US
Telephone Number	:	732-998-7344
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 PILGRIM PATHWAY APT 8
Second Line	:
City	:	OCEAN GROVE
State	:	NJ
Zip	:	07756-1551
Country	:	US
Telephone Number	:	732-998-7344
Fax Number	:

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

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	04/28/2021

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