MEDICARE: BAILEY MATTHEW WOOD 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	18667	NC
2	225700000X	Massage Therapist	103469	FL

General Provider Information

NPI Number	:	1851126619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY MATTHEW WOOD LMT

Provider Business Mailing Address
First Line	:	5319 SUMMERLIN RD APT 10
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7639
Country	:	US
Telephone Number	:	704-307-5096
Fax Number	:

Provider Business Practice Location Address
First Line	:	5319 SUMMERLIN RD APT 10
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7639
Country	:	US
Telephone Number	:	704-307-5096
Fax Number	:

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

Provider Enumeration Date	:	09/03/2024
Last Update Date	:	09/03/2024

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Directions to “ BAILEY MATTHEW WOOD LMT” Practice Location

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