MEDICARE: LIDIA NASH 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	MA46199	FL

General Provider Information

NPI Number	:	1770810335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIDIA NASH LMT

Provider Business Mailing Address
First Line	:	1365 BEVILLE RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1529
Country	:	US
Telephone Number	:	386-760-0035
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 BEVILLE RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1529
Country	:	US
Telephone Number	:	386-760-0035
Fax Number	:

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

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	11/03/2009

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