MEDICARE: TARA L JONES M.T.

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		VT

General Provider Information

NPI Number	:	1154588622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA L JONES M.T.

Provider Business Mailing Address
First Line	:	440 MAIN ST
Second Line	:
City	:	WINOOSKI
State	:	VT
Zip	:	05404-1338
Country	:	US
Telephone Number	:	802-655-0354
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 MAIN ST
Second Line	:
City	:	WINOOSKI
State	:	VT
Zip	:	05404-1338
Country	:	US
Telephone Number	:	802-655-0354
Fax Number	:

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

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	05/21/2008

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