MEDICARE: MS. MARY ROBERTS

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		MO

General Provider Information

NPI Number	:	1225424732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ROBERTS

Provider Business Mailing Address
First Line	:	2310 HWY 94 S OUTER RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-8301
Country	:	US
Telephone Number	:	636-552-4275
Fax Number	:	888-386-2172

Provider Business Practice Location Address
First Line	:	2310 HWY 94 S OUTER RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-8301
Country	:	US
Telephone Number	:	636-552-4275
Fax Number	:	888-386-2172

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

Provider Enumeration Date	:	04/10/2015
Last Update Date	:	04/10/2015

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Directions to “ MS. MARY ROBERTS ” Practice Location

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