MEDICARE: LYNDSI DAWN ROSEN 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	33.012628	OH

General Provider Information

NPI Number	:	1548475171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDSI DAWN ROSEN LMT

Provider Business Mailing Address
First Line	:	11240 CHEYENNE TRL
Second Line	:	B
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-9021
Country	:	US
Telephone Number	:	216-337-8005
Fax Number	:	216-491-3884

Provider Business Practice Location Address
First Line	:	3645 WARRENSVILLE CENTER RD
Second Line	:	121
City	:	SHAKER HTS
State	:	OH
Zip	:	44122-5247
Country	:	US
Telephone Number	:	216-491-3883
Fax Number	:	216-491-3884

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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