MEDICARE: DESIREE LATRICE ADAMS 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	MT013094	GA

General Provider Information

NPI Number	:	1568050094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE LATRICE ADAMS LMT

Provider Business Mailing Address
First Line	:	502 BAY LAUREL CIR
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-2947
Country	:	US
Telephone Number	:	478-444-5271
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 BAY LAUREL CIR
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-2947
Country	:	US
Telephone Number	:	478-444-5271
Fax Number	:

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

Provider Enumeration Date	:	01/10/2021
Last Update Date	:	01/20/2021

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Directions to “ DESIREE LATRICE ADAMS LMT” Practice Location

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