MEDICARE: POSH RELIEF, LLC

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	:	1700433190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSH RELIEF, LLC

Provider Business Mailing Address
First Line	:	701 7TH ST
Second Line	:
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-2624
Country	:	US
Telephone Number	:	763-229-5033
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 3RD ST
Second Line	:
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-2309
Country	:	US
Telephone Number	:	763-229-5033
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	HOLLIE BAHR
Credential	:	MEDICAL MASSAGE
Telephone Number	:	763-229-5033

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	08/21/2019

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