MEDICARE: BETH HELENE HUREWITZ BCTMB, ORD, LMT, LE

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	MA77793	FL

General Provider Information

NPI Number	:	1386110914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH HELENE HUREWITZ BCTMB, ORD, LMT, LE

Provider Business Mailing Address
First Line	:	213 6TH ST
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-7910
Country	:	US
Telephone Number	:	904-461-9962
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 6TH ST
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-7910
Country	:	US
Telephone Number	:	904-461-9962
Fax Number	:

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

Provider Enumeration Date	:	10/22/2018
Last Update Date	:	10/22/2018

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