Healthcare Provider Details

I. General information

NPI: 1245766021
Provider Name (Legal Business Name): ALLISON HAUGH MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 45TH ST
HIGHLAND IN
46322-2388
US

IV. Provider business mailing address

7203 DOVE DR
SCHERERVILLE IN
46375-3425
US

V. Phone/Fax

Practice location:
  • Phone: 219-218-2378
  • Fax:
Mailing address:
  • Phone: 219-218-2378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT21706024
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: