MEDICARE: MS. ELIZABETH HEUSTIS 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	1715407	KY

General Provider Information

NPI Number	:	1093332330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH HEUSTIS LMT

Provider Business Mailing Address
First Line	:	1012 BLUEGRASS AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-2314
Country	:	US
Telephone Number	:	502-457-6431
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 BLUEGRASS AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-2314
Country	:	US
Telephone Number	:	502-457-6431
Fax Number	:

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

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	07/02/2020

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