MEDICARE: FIONA YVONNE GREEN 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	MA33327	FL

General Provider Information

NPI Number	:	1649979865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FIONA YVONNE GREEN LMT

Provider Business Mailing Address
First Line	:	2113 SW 10TH AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33315-2403
Country	:	US
Telephone Number	:	954-560-7855
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 MIDDLE RIVER DR STE 201
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-3559
Country	:	US
Telephone Number	:	954-560-7855
Fax Number	:

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

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	02/27/2023

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