MEDICARE: DIANE M STEWART 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	MT030662	TX

General Provider Information

NPI Number	:	1609170893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE M STEWART LMT

Provider Business Mailing Address
First Line	:	9815 BENT BRANCH LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-2017
Country	:	US
Telephone Number	:	214-226-1407
Fax Number	:

Provider Business Practice Location Address
First Line	:	9815 BENT BRANCH LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-2017
Country	:	US
Telephone Number	:	214-226-1407
Fax Number	:

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

Provider Enumeration Date	:	01/02/2011
Last Update Date	:	01/02/2011

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