MEDICARE: DEBORAH ANN BENTON B.S., 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	0046	KY

General Provider Information

NPI Number	:	1184941593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH ANN BENTON B.S., L.M.T.

Provider Business Mailing Address
First Line	:	1467 S FORT THOMAS AVE
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-2453
Country	:	US
Telephone Number	:	859-781-8700
Fax Number	:	859-781-8701

Provider Business Practice Location Address
First Line	:	1467 S FORT THOMAS AVE
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-2453
Country	:	US
Telephone Number	:	859-781-8700
Fax Number	:	859-781-8701

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

Provider Enumeration Date	:	04/24/2010
Last Update Date	:	04/24/2010

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Directions to “ DEBORAH ANN BENTON B.S., L.M.T.” Practice Location

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