MEDICARE: MR. MICHAEL SIMMONS LMT, CLT

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	MA37889	FL

General Provider Information

NPI Number	:	1770571788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL SIMMONS LMT, CLT

Provider Business Mailing Address
First Line	:	19971 BACK NINE DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33498-4706
Country	:	US
Telephone Number	:	561-306-6618
Fax Number	:

Provider Business Practice Location Address
First Line	:	19971 BACK NINE DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33498-4706
Country	:	US
Telephone Number	:	561-306-6618
Fax Number	:

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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