MEDICARE: REBECCA ANN HERRMANN 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	MT10196	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT10196	OTHER	SD	LMT

General Provider Information

NPI Number	:	1841756251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ANN HERRMANN LMT

Provider Business Mailing Address
First Line	:	1610 S MINNESOTA AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1749
Country	:	US
Telephone Number	:	605-331-0588
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 S MINNESOTA AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1749
Country	:	US
Telephone Number	:	605-331-0588
Fax Number	:

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

Provider Enumeration Date	:	02/11/2019
Last Update Date	:	06/11/2019

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