MEDICARE: CHRIS THOMAS

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	MA55807	FL

General Provider Information

NPI Number	:	1326455114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRIS THOMAS

Provider Business Mailing Address
First Line	:	3031 NE 20TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S CONGRESS AVE
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-1347
Country	:	US
Telephone Number	:	561-214-9217
Fax Number	:

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

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	07/14/2014

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