MEDICARE: SUSAN FARHAT 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	MA36096	FL

General Provider Information

NPI Number	:	1639469158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN FARHAT LMT

Provider Business Mailing Address
First Line	:	9114 58TH DR E
Second Line	:	SUITE 112
City	:	BRADENTON
State	:	FL
Zip	:	34202-9074
Country	:	US
Telephone Number	:	941-320-9951
Fax Number	:

Provider Business Practice Location Address
First Line	:	9114 58TH DR E
Second Line	:	SUITE 112
City	:	BRADENTON
State	:	FL
Zip	:	34202-9074
Country	:	US
Telephone Number	:	941-320-9951
Fax Number	:

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

Provider Enumeration Date	:	04/18/2011
Last Update Date	:	04/18/2011

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