MEDICARE: A TOUCH OF GLORY MASSAGE THERAPY 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	:	1871247775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A TOUCH OF GLORY MASSAGE THERAPY LLC

Provider Business Mailing Address
First Line	:	5606 GREGORY CT
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-1637
Country	:	US
Telephone Number	:	757-782-1547
Fax Number	:	410-874-0977

Provider Business Practice Location Address
First Line	:	355 CRAWFORD ST STE 600C
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-2823
Country	:	US
Telephone Number	:	757-381-7395
Fax Number	:	410-874-0977

Authorized Official
Title or Position	:	CEO/CERTIFIED MASSAGE THERAPIST
Name	:	MR. EDWARD L SMITH
Credential	:	CMT
Telephone Number	:	757-782-1547

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	02/09/2022

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