MEDICARE: FAY HASSALL 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	MA50624	FL

General Provider Information

NPI Number	:	1639312853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAY HASSALL LMT

Provider Business Mailing Address
First Line	:	2312 NE 9TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3523
Country	:	US
Telephone Number	:	954-243-3352
Fax Number	:

Provider Business Practice Location Address
First Line	:	2312 NE 9TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3523
Country	:	US
Telephone Number	:	954-243-3352
Fax Number	:

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

Provider Enumeration Date	:	04/17/2009
Last Update Date	:	04/17/2009

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