MEDICARE: MARTHA F MOORE L.M.T.

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	MA38723	FL

General Provider Information

NPI Number	:	1710131065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA F MOORE L.M.T.

Provider Business Mailing Address
First Line	:	5201 SW 31ST AVE APT 105
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6922
Country	:	US
Telephone Number	:	954-547-3749
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 SW 31ST AVE APT 105
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6922
Country	:	US
Telephone Number	:	954-547-3749
Fax Number	:

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

Provider Enumeration Date	:	11/13/2008
Last Update Date	:	11/13/2008

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