MEDICARE: TERESA MARIE LIRUSSI 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	021025-1	NY

General Provider Information

NPI Number	:	1538337373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA MARIE LIRUSSI LMT

Provider Business Mailing Address
First Line	:	4917 WILLIAM ST
Second Line	:	SUITE A
City	:	LANCASTER
State	:	NY
Zip	:	14086-3200
Country	:	US
Telephone Number	:	716-706-0005
Fax Number	:	716-706-0220

Provider Business Practice Location Address
First Line	:	4917 WILLIAM ST
Second Line	:	SUITE A
City	:	LANCASTER
State	:	NY
Zip	:	14086-3200
Country	:	US
Telephone Number	:	716-706-0005
Fax Number	:	716-706-0220

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

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	02/14/2008

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