MEDICARE: MRS. SALLY-JOANNE POTTS 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	MA42499	FL

General Provider Information

NPI Number	:	1356467849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SALLY-JOANNE POTTS LMT

Provider Business Mailing Address
First Line	:	8340 NW 7TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6640
Country	:	US
Telephone Number	:	954-274-5953
Fax Number	:

Provider Business Practice Location Address
First Line	:	9050 PINES BLVD
Second Line	:	STE 450-6
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6455
Country	:	US
Telephone Number	:	954-274-5953
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	04/30/2008

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