MEDICARE: MICHAEL WESTGATE CMT

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	34895	CA

General Provider Information

NPI Number	:	1902280043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WESTGATE CMT

Provider Business Mailing Address
First Line	:	150 NELLEN AVE
Second Line	:	SUITE 200
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1104
Country	:	US
Telephone Number	:	415-924-2323
Fax Number	:	415-924-2323

Provider Business Practice Location Address
First Line	:	150 NELLEN AVE
Second Line	:	SUITE 200
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1104
Country	:	US
Telephone Number	:	415-225-4551
Fax Number	:	415-924-2323

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

Provider Enumeration Date	:	07/18/2015
Last Update Date	:	09/04/2015

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