MEDICARE: RICH SOLE 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	2003000885	MO

General Provider Information

NPI Number	:	1831446129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICH SOLE LMT

Provider Business Mailing Address
First Line	:	730 NW HIGHWAY 146
Second Line	:
City	:	TRENTON
State	:	MO
Zip	:	64683-7502
Country	:	US
Telephone Number	:	660-359-1839
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 W SAINT MAARTENS DR
Second Line	:	STE A
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2963
Country	:	US
Telephone Number	:	660-359-1839
Fax Number	:

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

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	08/06/2012

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