MEDICARE: NIKKI LYONS L.M.T.

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	MA62859	FL

General Provider Information

NPI Number	:	1487931457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI LYONS L.M.T.

Provider Business Mailing Address
First Line	:	26 N DAVIS ST
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3244
Country	:	US
Telephone Number	:	352-613-9007
Fax Number	:	352-794-3234

Provider Business Practice Location Address
First Line	:	26 N DAVIS ST
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3244
Country	:	US
Telephone Number	:	352-613-9007
Fax Number	:	352-794-3234

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

Provider Enumeration Date	:	11/04/2011
Last Update Date	:	11/04/2011

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