MEDICARE: APRIL R MACK 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	13330	OR

General Provider Information

NPI Number	:	1033443395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL R MACK LMT

Provider Business Mailing Address
First Line	:	677 MARY DR
Second Line	:
City	:	MOLALLA
State	:	OR
Zip	:	97038-7585
Country	:	US
Telephone Number	:	503-975-3742
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 MOLALLA AVE STE A
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-3787
Country	:	US
Telephone Number	:	503-657-3600
Fax Number	:

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

Provider Enumeration Date	:	09/18/2009
Last Update Date	:	09/18/2009

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