MEDICARE: CARMEN ROSE BOND LMT, CNMT

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	MT000696	GA

General Provider Information

NPI Number	:	1477749349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN ROSE BOND LMT, CNMT

Provider Business Mailing Address
First Line	:	1510 N THORNTON AVE STE 214
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-8517
Country	:	US
Telephone Number	:	770-548-1408
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 N THORNTON AVE STE 214
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-8517
Country	:	US
Telephone Number	:	770-548-1408
Fax Number	:

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

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	08/21/2015

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