MEDICARE: ASHER BAY 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	7042	NM

General Provider Information

NPI Number	:	1194092999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHER BAY L.M.T.

Provider Business Mailing Address
First Line	:	1212 SAN PABLO ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 SAN PABLO ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7240
Country	:	US
Telephone Number	:	505-803-6660
Fax Number	:

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

Provider Enumeration Date	:	11/21/2011
Last Update Date	:	11/21/2011

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