MEDICARE: MRS. STEPHEN C FORRESTER MASSAGE THERAPIST

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	171W00000X	Contractor	LA#0877	LA

General Provider Information

NPI Number	:	1780866160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHEN C FORRESTER MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	2150 BOYCE ST
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3707
Country	:	US
Telephone Number	:	318-441-2211
Fax Number	:	318-441-1111

Provider Business Practice Location Address
First Line	:	2150 BOYCE ST
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3707
Country	:	US
Telephone Number	:	318-441-2211
Fax Number	:	318-441-1111

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

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	11/28/2007

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