MEDICARE: LISA J SMITH 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	MA56206	FL
2	225700000X	Massage Therapist	MM27808	FL

General Provider Information

NPI Number	:	1548539752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA J SMITH LMT

Provider Business Mailing Address
First Line	:	1900 NE 28TH AVE
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-3119
Country	:	US
Telephone Number	:	954-415-6285
Fax Number	:	954-782-6564

Provider Business Practice Location Address
First Line	:	1915 NE 45TH ST
Second Line	:	SUITE 104B
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5199
Country	:	US
Telephone Number	:	954-415-6285
Fax Number	:	954-782-6564

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

Provider Enumeration Date	:	12/16/2011
Last Update Date	:	12/16/2011

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Directions to “ LISA J SMITH LMT” Practice Location

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