MEDICARE: MR. STEVEN MAYBERRY II 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	M04846	MD

General Provider Information

NPI Number	:	1326408956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN MAYBERRY II LMT

Provider Business Mailing Address
First Line	:	2503 DENNIS AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-4920
Country	:	US
Telephone Number	:	301-717-9572
Fax Number	:

Provider Business Practice Location Address
First Line	:	2503 DENNIS AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-4920
Country	:	US
Telephone Number	:	301-717-9572
Fax Number	:

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

Provider Enumeration Date	:	02/24/2016
Last Update Date	:	02/24/2016

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