MEDICARE: STEPHEN SMITH L.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	MA5866	FL

General Provider Information

NPI Number	:	1184033680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN SMITH L.M.T.

Provider Business Mailing Address
First Line	:	2821 E COMMERCIAL BLVD
Second Line	:	SUITE 100
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4216
Country	:	US
Telephone Number	:	954-776-1902
Fax Number	:	954-776-1930

Provider Business Practice Location Address
First Line	:	2821 E COMMERCIAL BLVD
Second Line	:	SUITE 100
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4216
Country	:	US
Telephone Number	:	954-776-1902
Fax Number	:	954-776-1930

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

Provider Enumeration Date	:	08/08/2014
Last Update Date	:	08/08/2014

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