MEDICARE: MR. ANTHONY PETER SCANU 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	14337	NY

General Provider Information

NPI Number	:	1528207305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY PETER SCANU LMT

Provider Business Mailing Address
First Line	:	390 OLD BEST RD
Second Line	:
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196-3015
Country	:	US
Telephone Number	:	518-283-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	1614 COLUMBIA TPKE
Second Line	:
City	:	CASTLETON ON HUDSON
State	:	NY
Zip	:	12033-9548
Country	:	US
Telephone Number	:	518-477-1007
Fax Number	:

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

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	02/18/2009

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