MEDICARE: VANESSA MCGLOTHEN 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	MT014694	GA

General Provider Information

NPI Number	:	1447065024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA MCGLOTHEN LMT

Provider Business Mailing Address
First Line	:	1950 BARRETT LAKES BLVD NW APT 1015
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-7532
Country	:	US
Telephone Number	:	405-206-4091
Fax Number	:

Provider Business Practice Location Address
First Line	:	3133 MAPLE DR NE STE 120
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2509
Country	:	US
Telephone Number	:	404-220-7770
Fax Number	:

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

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	02/11/2025

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