MEDICARE: MR. CHARLES RUBEN PILLOT 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	MA47152	FL

General Provider Information

NPI Number	:	1902002355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES RUBEN PILLOT L.M.T

Provider Business Mailing Address
First Line	:	7215 72ND WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-6730
Country	:	US
Telephone Number	:	561-707-8531
Fax Number	:

Provider Business Practice Location Address
First Line	:	6133 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3074
Country	:	US
Telephone Number	:	561-432-1399
Fax Number	:	561-432-1388

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/08/2007

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