MEDICARE: THERESA KATHLEEN GESSWEIN-JUSINO 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	026272	NY

General Provider Information

NPI Number	:	1174861660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA KATHLEEN GESSWEIN-JUSINO LMT

Provider Business Mailing Address
First Line	:	1217 12TH ST
Second Line	:
City	:	WEST BABYLON
State	:	NY
Zip	:	11704-3628
Country	:	US
Telephone Number	:	516-639-5719
Fax Number	:

Provider Business Practice Location Address
First Line	:	1217 12TH ST
Second Line	:
City	:	WEST BABYLON
State	:	NY
Zip	:	11704-3628
Country	:	US
Telephone Number	:	516-639-5719
Fax Number	:

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

Provider Enumeration Date	:	01/18/2013
Last Update Date	:	01/18/2013

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