MEDICARE: BRIAN K HULTMAN 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	016756	NY

General Provider Information

NPI Number	:	1467689471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN K HULTMAN LMT

Provider Business Mailing Address
First Line	:	2541 MONROE AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3123
Country	:	US
Telephone Number	:	585-271-4270
Fax Number	:

Provider Business Practice Location Address
First Line	:	2541 MONROE AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3123
Country	:	US
Telephone Number	:	585-271-4270
Fax Number	:

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

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	04/23/2012

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