MEDICARE: NICHOLAS HUETTE 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	04268	IA

General Provider Information

NPI Number	:	1417259052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS HUETTE LMT

Provider Business Mailing Address
First Line	:	71 PRIMROSE CT
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-6829
Country	:	US
Telephone Number	:	319-325-7765
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 STURGIS CORNER DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-5617
Country	:	US
Telephone Number	:	319-688-2974
Fax Number	:

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

Provider Enumeration Date	:	12/02/2010
Last Update Date	:	12/02/2010

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