=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821827882
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA LOUISE VALENTINE LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2024
-----------------------------------------------------
Last Update Date | 07/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4336 RED ARROW HWY
-----------------------------------------------------
City | STEVENSVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49127-8304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-487-6396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 371 COLOMA AVE
-----------------------------------------------------
City | COLOMA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49038-9724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-487-6396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 7501012080
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------