MEDICARE: EDWARD HALLERAN 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	MA57626	FL

General Provider Information

NPI Number	:	1013314855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD HALLERAN LMT

Provider Business Mailing Address
First Line	:	405 2ND ST S
Second Line	:	SUITE C
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-4014
Country	:	US
Telephone Number	:	727-463-3751
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 2ND ST S
Second Line	:	SUITE C
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-4014
Country	:	US
Telephone Number	:	727-463-3751
Fax Number	:

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

Provider Enumeration Date	:	11/21/2014
Last Update Date	:	11/21/2014

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