MEDICARE: MR. DANNY THOMAS O'DAY CMT

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	1508-046	WA

General Provider Information

NPI Number	:	1114556057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANNY THOMAS O'DAY CMT

Provider Business Mailing Address
First Line	:	2841 SARATOGA ST.
Second Line	:
City	:	WISCONSIN RAPIDS
State	:	WI
Zip	:	54494
Country	:	US
Telephone Number	:	715-213-3456
Fax Number	:

Provider Business Practice Location Address
First Line	:	2841 SARATOGA ST.
Second Line	:
City	:	WISCONSIN RAPIDS
State	:	WI
Zip	:	54494
Country	:	US
Telephone Number	:	715-213-3456
Fax Number	:

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

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	04/03/2020

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