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NPI Code Detail

MEDICARE: MS. JOHANNA RAE DEHOFF LMT

MEDICARE: MS. JOHANNA RAE DEHOFF 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
1225700000XMassage TherapistMT2656ME

General Provider Information

NPI Number : 1548680044
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JOHANNA RAE DEHOFF LMT
Provider Business Mailing Address
First Line : 26 CHESTNUT ST
Second Line :
City : ROCKLAND
State : ME
Zip : 04841-3044
Country : US
Telephone Number : 207-542-0308
Fax Number :
Provider Business Practice Location Address
First Line : 7 LIMEROCK ST
Second Line :
City : ROCKLAND
State : ME
Zip : 04841-2928
Country : US
Telephone Number : 207-594-2122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2014
Last Update Date : 04/23/2014

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