MEDICARE: CALL DOC MASSAGE THERAPY, INC.

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	MA25405	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA2540	OTHER	FL	INDIVIDUAL LICENSE
2	MM10439	OTHER	FL	ESTABLISHMENT LICENSE

General Provider Information

NPI Number	:	1912929886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALL DOC MASSAGE THERAPY, INC.

Provider Business Mailing Address
First Line	:	100 S DIXIE HWY
Second Line	:	SUITE #209
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5421
Country	:	US
Telephone Number	:	561-478-1122
Fax Number	:	561-366-4806

Provider Business Practice Location Address
First Line	:	100 S DIXIE HWY
Second Line	:	SUITE #209
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5421
Country	:	US
Telephone Number	:	561-478-1122
Fax Number	:	561-366-4806

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DANIEL M. GRIEF
Credential	:	L.M.T.
Telephone Number	:	561-478-1122

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	08/22/2020

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