MEDICARE: LYDIA R IRONS 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	9900	MA

General Provider Information

NPI Number	:	1407275688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA R IRONS LMT

Provider Business Mailing Address
First Line	:	55 HIGH ST # 2
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002-1810
Country	:	US
Telephone Number	:	603-833-1809
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 RUSSELL ST
Second Line	:	12C
City	:	HADLEY
State	:	MA
Zip	:	01035-9529
Country	:	US
Telephone Number	:	603-833-1809
Fax Number	:

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

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	04/15/2014

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