MEDICARE: MRS. EMMA ANNA SCALA 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	1563M

General Provider Information

NPI Number	:	1306052154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMMA ANNA SCALA LMT

Provider Business Mailing Address
First Line	:	171 OLD BAY RD
Second Line	:
City	:	NEW DURHAM
State	:	NH
Zip	:	03855
Country	:	US
Telephone Number	:	603-859-1608
Fax Number	:	603-859-6185

Provider Business Practice Location Address
First Line	:	171 OLD BAY RD
Second Line	:
City	:	NEW DURHAM
State	:	NH
Zip	:	03855
Country	:	US
Telephone Number	:	603-859-6185
Fax Number	:	603-859-6185

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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