MEDICARE: ROBERT L EBELHARDT 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	20705	FL

General Provider Information

NPI Number	:	1346577061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT L EBELHARDT LMT

Provider Business Mailing Address
First Line	:	401 33RD ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4815
Country	:	US
Telephone Number	:	561-723-2425
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 S FEDERAL HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-3837
Country	:	US
Telephone Number	:	561-723-2425
Fax Number	:

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

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	11/17/2009

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