MEDICARE: MRS. ELISABETH VICTORIA RALEY 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	4849	SC

General Provider Information

NPI Number	:	1699915637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELISABETH VICTORIA RALEY LMT

Provider Business Mailing Address
First Line	:	601 RIVERHILL CIR APT B3
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-8131
Country	:	US
Telephone Number	:	803-622-6569
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 AUGUSTA RD
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-6128
Country	:	US
Telephone Number	:	803-622-6569
Fax Number	:

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

Provider Enumeration Date	:	03/04/2009
Last Update Date	:	03/04/2009

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