MEDICARE: MR. CURTIS EBRAY EDMUNDS JR. MASSAGE THERAPIST

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	16006	NC

General Provider Information

NPI Number	:	1548789480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CURTIS EBRAY EDMUNDS JR. MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	1718 PINE COVE CT
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-9237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2714 HENNING DR STE 1
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-4502
Country	:	US
Telephone Number	:	434-429-9951
Fax Number	:

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

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	09/12/2017

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