MEDICARE: MS. FAITH LUCILLE MORRISON CMT

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	006593	CA

General Provider Information

NPI Number	:	1407028442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FAITH LUCILLE MORRISON CMT

Provider Business Mailing Address
First Line	:	PO BOX 1145
Second Line	:
City	:	KERNVILLE
State	:	CA
Zip	:	93238-1145
Country	:	US
Telephone Number	:	760-417-2068
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 KERN VALLEY PLAZA
Second Line	:	LAKE ISABELLA BLVD
City	:	LAKE ISABELLA
State	:	CA
Zip	:	93240
Country	:	US
Telephone Number	:	760-417-2068
Fax Number	:

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

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	03/31/2008

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