MEDICARE: TARA QUINN MASSAGE THERAPIST

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	55209	CA

General Provider Information

NPI Number	:	1124634274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA QUINN MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	5279 E THE TOLEDO APT 2
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-1883
Country	:	US
Telephone Number	:	310-493-2995
Fax Number	:

Provider Business Practice Location Address
First Line	:	5279 E THE TOLEDO APT 25279E
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-1862
Country	:	US
Telephone Number	:	310-493-2995
Fax Number	:

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

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	10/16/2020

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Directions to “ TARA QUINN MASSAGE THERAPIST” Practice Location

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