MEDICARE: FARON KEITH PASCHAL MEDICAL MASSAGE THER

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	MT102936	TX

General Provider Information

NPI Number	:	1285909804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARON KEITH PASCHAL MEDICAL MASSAGE THER

Provider Business Mailing Address
First Line	:	5020 50TH ST UNIT 101
Second Line	:	YORKTOWN PLAZA
City	:	LUBBOCK
State	:	TX
Zip	:	79414-3422
Country	:	US
Telephone Number	:	806-548-6061
Fax Number	:

Provider Business Practice Location Address
First Line	:	5020 50TH ST UNIT 101
Second Line	:	YORKTOWN PLAZA
City	:	LUBBOCK
State	:	TX
Zip	:	79414-3422
Country	:	US
Telephone Number	:	806-548-6061
Fax Number	:

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

Provider Enumeration Date	:	03/14/2012
Last Update Date	:	03/14/2012

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Directions to “ FARON KEITH PASCHAL MEDICAL MASSAGE THER” Practice Location

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