MEDICARE: JACOB VAN NORMAN 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	LMT-LMT-LIC-9839	MT

General Provider Information

NPI Number	:	1881135739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB VAN NORMAN LMT

Provider Business Mailing Address
First Line	:	1625 HARRISON AVE
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-5401
Country	:	US
Telephone Number	:	406-565-8443
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 HARRISON AVE
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-5401
Country	:	US
Telephone Number	:	406-565-8443
Fax Number	:

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

Provider Enumeration Date	:	03/11/2017
Last Update Date	:	03/11/2017

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Directions to “ JACOB VAN NORMAN LMT” Practice Location

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