MEDICARE: MRS. BELINDA MAVIS GARRETT-IBE 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	MT000740	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT000740	OTHER	GA	GEORGIA MASSAGE THERAPIST LICENSE

General Provider Information

NPI Number	:	1144516279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BELINDA MAVIS GARRETT-IBE MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	1551 PARK GROVE DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4398
Country	:	US
Telephone Number	:	770-771-2570
Fax Number	:

Provider Business Practice Location Address
First Line	:	3444 CLUB DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-2402
Country	:	US
Telephone Number	:	770-771-2570
Fax Number	:

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

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	06/27/2011

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