MEDICARE: TETYANA M DAVIS 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	33015203	OH

General Provider Information

NPI Number	:	1598982852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TETYANA M DAVIS LMT

Provider Business Mailing Address
First Line	:	781 BETA DR
Second Line	:	SUITE K
City	:	CLEVELAND
State	:	OH
Zip	:	44143-2356
Country	:	US
Telephone Number	:	216-374-2138
Fax Number	:

Provider Business Practice Location Address
First Line	:	781 BETA DR
Second Line	:	SUITE K
City	:	CLEVELAND
State	:	OH
Zip	:	44143-2356
Country	:	US
Telephone Number	:	216-374-2138
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/08/2007

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