MEDICARE: MS. MARTINE MINER L.M.T., NCTMB

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	172M00000X	Mechanotherapist	426016-00	MA

General Provider Information

NPI Number	:	1073728416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTINE MINER L.M.T., NCTMB

Provider Business Mailing Address
First Line	:	12 KENNEY LN
Second Line	:
City	:	NORTH ATTLEBORO
State	:	MA
Zip	:	02760-4147
Country	:	US
Telephone Number	:	508-643-0480
Fax Number	:	508-384-7336

Provider Business Practice Location Address
First Line	:	844 FRANKLIN ST
Second Line	:	UNIT 9
City	:	WRENTHAM
State	:	MA
Zip	:	02093-1223
Country	:	US
Telephone Number	:	508-384-3436
Fax Number	:	508-384-7336

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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