MEDICARE: MR. MICHAEL SHAY LMT CNC

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	006367	IA

General Provider Information

NPI Number	:	1215440177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL SHAY LMT CNC

Provider Business Mailing Address
First Line	:	2000 N COURT ST TRLR 5D
Second Line	:
City	:	FAIRFIELD
State	:	IA
Zip	:	52556-2005
Country	:	US
Telephone Number	:	641-472-3638
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 N COURT ST TRLR 5D
Second Line	:
City	:	FAIRFIELD
State	:	IA
Zip	:	52556-5255
Country	:	US
Telephone Number	:	641-472-3638
Fax Number	:	641-472-3638

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

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	11/14/2017

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