=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851677363
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NERAC THERAPEUTIC TOUCH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2011
-----------------------------------------------------
Last Update Date | 10/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 860 LARGO CENTER DR
-----------------------------------------------------
City | LARGO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20774-3705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-442-4882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6567
-----------------------------------------------------
City | LARGO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20792-6567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-442-4882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. CAREN C CLIFT
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 301-442-4882
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | M02449
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP3300X
-----------------------------------------------------
Taxonomy Name | Pain Clinic/Center
-----------------------------------------------------
License Number | M02449
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------