MEDICARE: MRS. LILLA ABDAL-HAQQ 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	MSG003565	PA

General Provider Information

NPI Number	:	1770993602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILLA ABDAL-HAQQ LMT

Provider Business Mailing Address
First Line	:	5937 A ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-2003
Country	:	US
Telephone Number	:	215-268-7105
Fax Number	:	215-224-2739

Provider Business Practice Location Address
First Line	:	5937 A ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-2003
Country	:	US
Telephone Number	:	215-268-7105
Fax Number	:	215-224-2739

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

Provider Enumeration Date	:	04/30/2014
Last Update Date	:	04/30/2014

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