MEDICARE: MR. VALEDEAR HIGHSMITH NCTMB

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	:	1548589260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VALEDEAR HIGHSMITH NCTMB

Provider Business Mailing Address
First Line	:	1829 GUERNSEY AVE
Second Line	:
City	:	ABINGTON
State	:	PA
Zip	:	19001-3805
Country	:	US
Telephone Number	:	215-776-0518
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 EASTON RD
Second Line	:	SUITE M200
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-2028
Country	:	US
Telephone Number	:	215-776-0518
Fax Number	:

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

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	05/19/2010

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