MEDICARE: MS. HELEN E MOSS 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	972	SD

General Provider Information

NPI Number	:	1639476088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HELEN E MOSS LMT

Provider Business Mailing Address
First Line	:	307 MAIN ST
Second Line	:
City	:	NORTH SIOUX CITY
State	:	SD
Zip	:	57049-3099
Country	:	US
Telephone Number	:	712-281-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	1323 RIVER DR
Second Line	:
City	:	NORTH SIOUX CITY
State	:	SD
Zip	:	57049-3015
Country	:	US
Telephone Number	:	712-281-7311
Fax Number	:

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

Provider Enumeration Date	:	02/22/2011
Last Update Date	:	02/22/2011

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