MEDICARE: TOMA MASSAGE, LLC

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	108562	KY

General Provider Information

NPI Number	:	1821506262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOMA MASSAGE, LLC

Provider Business Mailing Address
First Line	:	20 N GRAND AVE STE 12A
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-1781
Country	:	US
Telephone Number	:	859-442-8662
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 N GRAND AVE STE 12A
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-1781
Country	:	US
Telephone Number	:	859-442-8662
Fax Number	:

Authorized Official
Title or Position	:	MEMBER/OWNER
Name	:	TODD ALAN THOMAS
Credential	:	LMT, BCTMB
Telephone Number	:	859-442-8662

Provider Enumeration Date	:	01/19/2018
Last Update Date	:	01/19/2018

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