MEDICARE: MS. EVETTE DELPHINE SMITH 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	09-00006251	CA

General Provider Information

NPI Number	:	1780838730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EVETTE DELPHINE SMITH LMT

Provider Business Mailing Address
First Line	:	9616 WALNUT AVE
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-2324
Country	:	US
Telephone Number	:	916-686-1873
Fax Number	:	916-686-1874

Provider Business Practice Location Address
First Line	:	9616 WALNUT AVE
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-2324
Country	:	US
Telephone Number	:	916-686-1873
Fax Number	:	916-686-1874

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

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

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