MEDICARE: ROBIN WOOTEN LMT, CPT

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	MT-15654	AZ

General Provider Information

NPI Number	:	1346836525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN WOOTEN LMT, CPT

Provider Business Mailing Address
First Line	:	1558 W NOPAL AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-7548
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1558 W NOPAL AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-7548
Country	:	US
Telephone Number	:	602-370-2236
Fax Number	:

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

Provider Enumeration Date	:	12/11/2020
Last Update Date	:	12/11/2020

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