MEDICARE: MRS. SUSAN LYNN LAPHAM 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	MA25772	FL

General Provider Information

NPI Number	:	1942343538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN LYNN LAPHAM LMT

Provider Business Mailing Address
First Line	:	2418 MARATHON LN
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-4610
Country	:	US
Telephone Number	:	954-583-9254
Fax Number	:	954-791-7787

Provider Business Practice Location Address
First Line	:	2300 SE 4TH AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-3902
Country	:	US
Telephone Number	:	954-830-3864
Fax Number	:	954-791-7787

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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