MEDICARE: TEREZ LEO 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	MA29942	FL

General Provider Information

NPI Number	:	1952506248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEREZ LEO LMT

Provider Business Mailing Address
First Line	:	1541 S OCEAN BLVD
Second Line	:	APT. 124
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-7431
Country	:	US
Telephone Number	:	954-629-8595
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 NE 34TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-6906
Country	:	US
Telephone Number	:	954-629-8595
Fax Number	:

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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