MEDICARE: MS. TERESA L. COHEN 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	MA29669	FL

General Provider Information

NPI Number	:	1184826026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA L. COHEN LMT

Provider Business Mailing Address
First Line	:	108 HERON BAY CIR
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3420
Country	:	US
Telephone Number	:	407-328-5110
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 HERON BAY CIR
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3420
Country	:	US
Telephone Number	:	407-328-5110
Fax Number	:

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/09/2007

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