MEDICARE: RENATA CHRISTINE SEGOBIA CMT

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

General Provider Information

NPI Number	:	1942513395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENATA CHRISTINE SEGOBIA CMT

Provider Business Mailing Address
First Line	:	710 DAYTON AVE
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-2102
Country	:	US
Telephone Number	:	269-806-4421
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 DAYTON AVE
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-2102
Country	:	US
Telephone Number	:	269-806-4421
Fax Number	:

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

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	07/14/2010

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