MEDICARE: RACHAEL MARIE BOGUMIL 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	020179	NY

General Provider Information

NPI Number	:	1932363348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL MARIE BOGUMIL LMT

Provider Business Mailing Address
First Line	:	3030 ORCHARD PARK RD
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-4638
Country	:	US
Telephone Number	:	716-675-2258
Fax Number	:	716-675-2250

Provider Business Practice Location Address
First Line	:	3030 ORCHARD PARK RD
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-4638
Country	:	US
Telephone Number	:	716-675-2258
Fax Number	:	716-675-2250

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

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	07/15/2008

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