MEDICARE: MS. KATHY ROSE 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	014450	NY

General Provider Information

NPI Number	:	1093937690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHY ROSE LMT

Provider Business Mailing Address
First Line	:	410 S MAIN ST
Second Line	:	#3
City	:	GENEVA
State	:	NY
Zip	:	14456-3151
Country	:	US
Telephone Number	:	315-781-2560
Fax Number	:

Provider Business Practice Location Address
First Line	:	751 PRE EMPTION RD
Second Line	:	SUITE 2
City	:	GENEVA
State	:	NY
Zip	:	14456-1335
Country	:	US
Telephone Number	:	315-789-8212
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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