MEDICARE: RONALD SNOW MASSAGE THERAPIST

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	171W00000X	Contractor	MT001916	GA
2	171W00000X	Contractor	MASSAGE 1666	AL

General Provider Information

NPI Number	:	1306205562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD SNOW MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	800 PEACHTREE ST NE APT 1310
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-6027
Country	:	US
Telephone Number	:	205-362-1877
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 PEACHTREE ST NE APT 1310
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-6027
Country	:	US
Telephone Number	:	205-362-1877
Fax Number	:

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

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	02/16/2016

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