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NPI Code Detail

MEDICARE: RALEIGH JOSEPH SMITH

MEDICARE:   RALEIGH JOSEPH SMITH
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
1225700000XMassage TherapistMT22107394IN

General Provider Information

NPI Number : 1104569672
Entity Type Code : Individual
Provider Name (Legal Business Name) : RALEIGH JOSEPH SMITH
Provider Business Mailing Address
First Line : 4641 ENGLEWOOD DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46226-2620
Country : US
Telephone Number : 606-391-5043
Fax Number :
Provider Business Practice Location Address
First Line : 4641 ENGLEWOOD DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46226-2620
Country : US
Telephone Number : 606-391-5043
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2022
Last Update Date : 04/13/2022

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Directions to “ RALEIGH JOSEPH SMITH ” Practice Location

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