MEDICARE: LIN TAO

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	34374	CA

General Provider Information

NPI Number	:	1437581709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIN TAO

Provider Business Mailing Address
First Line	:	24531 TRABUCO RD STE C
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-2162
Country	:	US
Telephone Number	:	626-417-8633
Fax Number	:

Provider Business Practice Location Address
First Line	:	24531 TRABUCO RD STE C
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-2162
Country	:	US
Telephone Number	:	626-417-8633
Fax Number	:

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

Provider Enumeration Date	:	08/08/2013
Last Update Date	:	08/08/2013

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Directions to “ LIN TAO ” Practice Location

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