MEDICARE: ADVANCED MASSAGE HEALTHCARE, INC.

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	1234	NE

General Provider Information

NPI Number	:	1669692117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MASSAGE HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	3601 CALVERT ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506
Country	:	US
Telephone Number	:	402-423-2643
Fax Number	:	402-423-2644

Provider Business Practice Location Address
First Line	:	3601 CALVERT ST
Second Line	:	34
City	:	LINCOLN
State	:	NE
Zip	:	68506-5797
Country	:	US
Telephone Number	:	402-423-2643
Fax Number	:	402-423-2644

Authorized Official
Title or Position	:	OWNER
Name	:	BRADLEY DEAN DECKER
Credential	:	L.M.T.
Telephone Number	:	402-423-2643

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	08/24/2016

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