MEDICARE: MATTHEW DAVID REINSTATLER L.M.T.

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	MA47678	FL

General Provider Information

NPI Number	:	1821114638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW DAVID REINSTATLER L.M.T.

Provider Business Mailing Address
First Line	:	728 W 23RD ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-3923
Country	:	US
Telephone Number	:	850-784-9001
Fax Number	:	850-784-1910

Provider Business Practice Location Address
First Line	:	728 W 23RD ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-3923
Country	:	US
Telephone Number	:	850-784-9001
Fax Number	:	850-784-1910

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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