MEDICARE: THOMEISHA CARTER

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	MT122732	TX
2	225700000X	Massage Therapist	227.015879	IL

General Provider Information

NPI Number	:	1003271511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMEISHA CARTER

Provider Business Mailing Address
First Line	:	4811 LIKINS CIR APT 204
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-4202
Country	:	US
Telephone Number	:	773-663-5764
Fax Number	:

Provider Business Practice Location Address
First Line	:	4811 LIKINS CIR APT 204
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-4202
Country	:	US
Telephone Number	:	773-663-5764
Fax Number	:

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

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	12/28/2015

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Directions to “ THOMEISHA CARTER ” Practice Location

Language	Start Address	Practice Location

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