MEDICARE: PHYLLIS ELAINE FIRTH - GUTZ 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	MSG001950	OR

General Provider Information

NPI Number	:	1598017345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS ELAINE FIRTH - GUTZ LMT

Provider Business Mailing Address
First Line	:	9146 E LAKE RD
Second Line	:
City	:	WESTFIELD
State	:	NY
Zip	:	14787-9528
Country	:	US
Telephone Number	:	171-632-6662
Fax Number	:

Provider Business Practice Location Address
First Line	:	9146 E LAKE RD
Second Line	:
City	:	WESTFIELD
State	:	NY
Zip	:	14787-9528
Country	:	US
Telephone Number	:	171-632-6662
Fax Number	:

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

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/03/2012

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