MEDICARE: TIMOTHY JOSEPH SMITH 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	MA61412	FL

General Provider Information

NPI Number	:	1063799666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY JOSEPH SMITH LMT

Provider Business Mailing Address
First Line	:	8771 STIRLING RD
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-5932
Country	:	US
Telephone Number	:	954-603-1311
Fax Number	:

Provider Business Practice Location Address
First Line	:	8771 STIRLING RD
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-5932
Country	:	US
Telephone Number	:	954-603-1311
Fax Number	:

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

Provider Enumeration Date	:	11/10/2011
Last Update Date	:	11/10/2011

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