MEDICARE: MAUREEN MCCARTHY LYDA 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	225700000X	Massage Therapist	MA4835	FL

General Provider Information

NPI Number	:	1992934293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN MCCARTHY LYDA L.M.T.

Provider Business Mailing Address
First Line	:	951 OLD DIXIE HWY
Second Line	:	A-3
City	:	VERO BEACH
State	:	FL
Zip	:	32960-4311
Country	:	US
Telephone Number	:	772-538-3081
Fax Number	:

Provider Business Practice Location Address
First Line	:	951 OLD DIXIE HWY
Second Line	:	A-3
City	:	VERO BEACH
State	:	FL
Zip	:	32960-4311
Country	:	US
Telephone Number	:	772-538-3081
Fax Number	:

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

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	07/08/2009

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