MEDICARE: MS. MELODY PAGE 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	172M00000X	Mechanotherapist	MA62355	FL

General Provider Information

NPI Number	:	1922392075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELODY PAGE L.M.T

Provider Business Mailing Address
First Line	:	25 W PLUMOSA LN
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-4836
Country	:	US
Telephone Number	:	561-676-6892
Fax Number	:

Provider Business Practice Location Address
First Line	:	6620 LAKE WORTH RD
Second Line	:	UNIT C
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-1518
Country	:	US
Telephone Number	:	561-676-6892
Fax Number	:

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

Provider Enumeration Date	:	06/07/2011
Last Update Date	:	06/07/2011

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