MEDICARE: LYAM CRISTINA WASKO 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	172M00000X	Mechanotherapist	MA 43950	FL

General Provider Information

NPI Number	:	1477798866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYAM CRISTINA WASKO LMT

Provider Business Mailing Address
First Line	:	15212 99TH ST N
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33412-2536
Country	:	US
Telephone Number	:	561-779-5985
Fax Number	:	561-798-5303

Provider Business Practice Location Address
First Line	:	15212 99TH ST N
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33412-2536
Country	:	US
Telephone Number	:	561-779-5985
Fax Number	:	561-798-5303

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

Provider Enumeration Date	:	12/13/2008
Last Update Date	:	12/13/2008

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