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NPI Code Detail

MEDICARE: MR. CEDRIC CARLTON GILBERT MASSAGE THERAPIST

MEDICARE:  MR. CEDRIC CARLTON GILBERT  MASSAGE THERAPIST
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
1225700000XMassage TherapistMT008581GA

General Provider Information

NPI Number : 1063026656
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CEDRIC CARLTON GILBERT MASSAGE THERAPIST
Provider Business Mailing Address
First Line : 717 LEE ST SW APT 211
Second Line :
City : ATLANTA
State : GA
Zip : 30310-2786
Country : US
Telephone Number : 404-358-0570
Fax Number :
Provider Business Practice Location Address
First Line : 717 LEE ST SW APT 211
Second Line :
City : ATLANTA
State : GA
Zip : 30310-2786
Country : US
Telephone Number : 404-358-0570
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2020
Last Update Date : 09/01/2020

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Directions to “ MR. CEDRIC CARLTON GILBERT MASSAGE THERAPIST” Practice Location

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