MEDICARE: BETH ANN HENNING LMT, CMT

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

General Provider Information

NPI Number	:	1366274524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH ANN HENNING LMT, CMT

Provider Business Mailing Address
First Line	:	2940 65TH ST E
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-2040
Country	:	US
Telephone Number	:	651-451-1012
Fax Number	:	651-453-1543

Provider Business Practice Location Address
First Line	:	2940 65TH ST E
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-2040
Country	:	US
Telephone Number	:	651-451-1012
Fax Number	:	651-453-1543

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

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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