MEDICARE: MISS GINA G 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	029823	NY

General Provider Information

NPI Number	:	1083250708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GINA G SMITH LMT

Provider Business Mailing Address
First Line	:	395 LEXINGTON AVE APT 1D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-1243
Country	:	US
Telephone Number	:	347-353-3090
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 LEXINGTON AVE APT 1D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-1243
Country	:	US
Telephone Number	:	347-353-3090
Fax Number	:

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

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	11/19/2019

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