MEDICARE: MS. MARY CHARLOTTE GALIPEAU 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	010255	NY

General Provider Information

NPI Number	:	1851465827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY CHARLOTTE GALIPEAU LMT

Provider Business Mailing Address
First Line	:	POST OFFICE BOX 76
Second Line	:
City	:	THOMPSON RIDGE
State	:	NY
Zip	:	10985
Country	:	US
Telephone Number	:	845-733-6100
Fax Number	:	845-733-6161

Provider Business Practice Location Address
First Line	:	22 NORTH ROAD
Second Line	:
City	:	BLOOMINGBURG
State	:	NY
Zip	:	12721
Country	:	US
Telephone Number	:	845-733-6100
Fax Number	:	845-733-6161

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/31/2011

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