MEDICARE: MRS. LYDIE ROBSHAM

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	MA29544	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C1070	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1235425539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYDIE ROBSHAM

Provider Business Mailing Address
First Line	:	2708 LAKE OSBORNE DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-5665
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2708 LAKE OSBORNE DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-5665
Country	:	US
Telephone Number	:	561-856-0131
Fax Number	:

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

Provider Enumeration Date	:	06/24/2011
Last Update Date	:	06/24/2011

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