MEDICARE: J. SCOTT GLEATON 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	3655	AL

General Provider Information

NPI Number	:	1598104309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	J. SCOTT GLEATON LMT

Provider Business Mailing Address
First Line	:	10515 US HIGHWAY 431
Second Line	:
City	:	LAFAYETTE
State	:	AL
Zip	:	36862-5421
Country	:	US
Telephone Number	:	334-497-5253
Fax Number	:

Provider Business Practice Location Address
First Line	:	189 E UNIVERSITY DR
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36832-6725
Country	:	US
Telephone Number	:	334-497-5253
Fax Number	:

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

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	06/14/2013

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