MEDICARE: JUSTIN M ORDON L.M.T

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	27017513	NY

General Provider Information

NPI Number	:	1124238647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN M ORDON L.M.T

Provider Business Mailing Address
First Line	:	6484 BROADWAY ST
Second Line	:
City	:	LANCASTER
State	:	NY
Zip	:	14086-9555
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4917 WILLIAM ST
Second Line	:	SUITE A
City	:	LANCASTER
State	:	NY
Zip	:	14086-3200
Country	:	US
Telephone Number	:	716-706-0005
Fax Number	:	716-706-0220

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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