MEDICARE: RESTORATIVE BODYWORK

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	6932	SC

General Provider Information

NPI Number	:	1780010645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATIVE BODYWORK

Provider Business Mailing Address
First Line	:	1625 LAKE MURRAY BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-8626
Country	:	US
Telephone Number	:	803-403-2056
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 LAKE MURRAY BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-8626
Country	:	US
Telephone Number	:	803-403-2056
Fax Number	:

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	KAITLYN FLANAGAN
Credential	:	LMT
Telephone Number	:	843-425-3432

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	09/23/2013

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Directions to “RESTORATIVE BODYWORK ” Practice Location

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