MEDICARE: MS. COURTNEY DICARLO CMT, 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	MT001781	GA

General Provider Information

NPI Number	:	1386941078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COURTNEY DICARLO CMT, LMT

Provider Business Mailing Address
First Line	:	675 PULASKI ST
Second Line	:	SUITE 1300
City	:	ATHENS
State	:	GA
Zip	:	30601-2378
Country	:	US
Telephone Number	:	706-352-9078
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 PULASKI ST
Second Line	:	SUITE 1300
City	:	ATHENS
State	:	GA
Zip	:	30601-2378
Country	:	US
Telephone Number	:	706-352-9078
Fax Number	:

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

Provider Enumeration Date	:	02/16/2011
Last Update Date	:	02/16/2011

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