MEDICARE: TIMOTHY S WARBURTON 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	009408	PA

General Provider Information

NPI Number	:	1639775885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY S WARBURTON LMT

Provider Business Mailing Address
First Line	:	5904 COTTAGE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-4005
Country	:	US
Telephone Number	:	267-357-5529
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 E ALLEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-4140
Country	:	US
Telephone Number	:	267-357-5529
Fax Number	:

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

Provider Enumeration Date	:	12/11/2020
Last Update Date	:	12/11/2020

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