MEDICARE: MR. REX LEE ROMANS 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	MT-08693	AZ

General Provider Information

NPI Number	:	1376615377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. REX LEE ROMANS LMT

Provider Business Mailing Address
First Line	:	1438 E CAROL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2228
Country	:	US
Telephone Number	:	602-692-8709
Fax Number	:

Provider Business Practice Location Address
First Line	:	1438 E CAROL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2228
Country	:	US
Telephone Number	:	602-692-8709
Fax Number	:

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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