MEDICARE: MR. ROBERT TRICOMI 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	2339	MA

General Provider Information

NPI Number	:	1215576616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT TRICOMI LMT

Provider Business Mailing Address
First Line	:	PO BOX 211
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-0003
Country	:	US
Telephone Number	:	978-407-4490
Fax Number	:

Provider Business Practice Location Address
First Line	:	1666 MASSACHUSETTS AVE STE 6
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-5313
Country	:	US
Telephone Number	:	781-860-2324
Fax Number	:

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

Provider Enumeration Date	:	01/02/2020
Last Update Date	:	01/02/2020

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