MEDICARE: MUNEERAH LISON AUSTIN

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	09611	NC

General Provider Information

NPI Number	:	1710286406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUNEERAH LISON AUSTIN

Provider Business Mailing Address
First Line	:	910 CRYSTAL BLUFF LN APT 103
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27601-2777
Country	:	US
Telephone Number	:	919-986-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 CRYSTAL BLUFF LN APT 103
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27601-2777
Country	:	US
Telephone Number	:	919-986-7000
Fax Number	:

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

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	03/21/2011

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