MEDICARE: ZANDRIA REMY 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	011631	GA

General Provider Information

NPI Number	:	1144822727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZANDRIA REMY LMT

Provider Business Mailing Address
First Line	:	PO BOX 76260
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30358-1260
Country	:	US
Telephone Number	:	850-296-7041
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 SPRING CREEK LN
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-3844
Country	:	US
Telephone Number	:	850-296-7041
Fax Number	:

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

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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