MEDICARE: COURTNEY VASHRO 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	MT3710	ME

General Provider Information

NPI Number	:	1437617172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY VASHRO LMT

Provider Business Mailing Address
First Line	:	PO BOX 491
Second Line	:
City	:	MOUNT DESERT
State	:	ME
Zip	:	04660-0491
Country	:	US
Telephone Number	:	607-351-1280
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 HERRICK RD
Second Line	:
City	:	SOUTHWEST HARBOR
State	:	ME
Zip	:	04679-4431
Country	:	US
Telephone Number	:	607-351-1280
Fax Number	:

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

Provider Enumeration Date	:	03/12/2019
Last Update Date	:	03/12/2019

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Directions to “ COURTNEY VASHRO LMT” Practice Location

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