MEDICARE: MICHAEL LEBO L.M.T

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	MT125229	TX

General Provider Information

NPI Number	:	1851023253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LEBO L.M.T

Provider Business Mailing Address
First Line	:	5320 GOODING DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78744-5401
Country	:	US
Telephone Number	:	512-589-3984
Fax Number	:

Provider Business Practice Location Address
First Line	:	5320 GOODING DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78744-5401
Country	:	US
Telephone Number	:	512-589-3984
Fax Number	:

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

Provider Enumeration Date	:	06/26/2022
Last Update Date	:	06/26/2022

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