MEDICARE: MS. KATHLEEN ANN BENANTI 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	043740	TX

General Provider Information

NPI Number	:	1588781843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN ANN BENANTI L.M.T.

Provider Business Mailing Address
First Line	:	714 MONTE VISTA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75223-1244
Country	:	US
Telephone Number	:	214-766-6876
Fax Number	:

Provider Business Practice Location Address
First Line	:	6162 E MOCKINGBIRD LN STE 205
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-6930
Country	:	US
Telephone Number	:	214-766-6876
Fax Number	:

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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