MEDICARE: MR. THOMAS LIBERTO 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	MA0003690	FL

General Provider Information

NPI Number	:	1134439730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS LIBERTO LMT

Provider Business Mailing Address
First Line	:	1123 N FEDERAL HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-2353
Country	:	US
Telephone Number	:	561-582-2306
Fax Number	:	561-582-2307

Provider Business Practice Location Address
First Line	:	1123 N FEDERAL HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-2353
Country	:	US
Telephone Number	:	561-582-2306
Fax Number	:	561-582-2307

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

Provider Enumeration Date	:	10/15/2010
Last Update Date	:	10/15/2010

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