MEDICARE: RENEE BARIBAULT LMP

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	MA 60198888	WA

General Provider Information

NPI Number	:	1861853202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE BARIBAULT LMP

Provider Business Mailing Address
First Line	:	PO BOX 1544
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-0051
Country	:	US
Telephone Number	:	360-531-3681
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 ST HELENS PL
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-4721
Country	:	US
Telephone Number	:	360-531-3681
Fax Number	:

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

Provider Enumeration Date	:	03/13/2016
Last Update Date	:	03/13/2016

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