MEDICARE: LISA MERTZ 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	8921	NY

General Provider Information

NPI Number	:	1134750680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MERTZ LMT

Provider Business Mailing Address
First Line	:	85 S ERIE ST
Second Line	:
City	:	MAYVILLE
State	:	NY
Zip	:	14757-1114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 S ERIE ST
Second Line	:
City	:	MAYVILLE
State	:	NY
Zip	:	14757-1114
Country	:	US
Telephone Number	:	716-708-5675
Fax Number	:

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

Provider Enumeration Date	:	02/03/2020
Last Update Date	:	02/03/2020

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