MEDICARE: MRS. RHENA ANNE SMITH 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	227011995	IL

General Provider Information

NPI Number	:	1184100497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RHENA ANNE SMITH LMT

Provider Business Mailing Address
First Line	:	212 WEBSTER ST
Second Line	:
City	:	MONTGOMERY
State	:	IL
Zip	:	60538-1324
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 WEBSTER ST
Second Line	:
City	:	MONTGOMERY
State	:	IL
Zip	:	60538-1324
Country	:	US
Telephone Number	:	630-896-1919
Fax Number	:

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

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	07/19/2018

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