=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104149459
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH TOUCH MASSAGE THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2010
-----------------------------------------------------
Last Update Date | 03/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1408 19TH ST STE. D
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-3527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-562-8905
-----------------------------------------------------
Fax | 772-562-7071
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1408 19TH ST STE. D
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-3527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-562-8905
-----------------------------------------------------
Fax | 772-562-7071
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANN L HOLLENBECK
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 772-562-8905
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MM7969
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------