MEDICARE: MARTA TANDA 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	MA40079	FL

General Provider Information

NPI Number	:	1851530208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTA TANDA LMT

Provider Business Mailing Address
First Line	:	4854 NW 7TH ST APT 510
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2190
Country	:	US
Telephone Number	:	305-793-2090
Fax Number	:

Provider Business Practice Location Address
First Line	:	4854 NW 7TH ST APT 510
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2190
Country	:	US
Telephone Number	:	305-793-2090
Fax Number	:

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

Provider Enumeration Date	:	02/09/2009
Last Update Date	:	02/09/2009

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Directions to “ MARTA TANDA LMT” Practice Location

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