MEDICARE: ELIZABETH ANN NICHOLAS CMT

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		MN

General Provider Information

NPI Number	:	1922708569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN NICHOLAS CMT

Provider Business Mailing Address
First Line	:	PO BOX 44
Second Line	:
City	:	HILLMAN
State	:	MN
Zip	:	56338-0044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 E BROADWAY
Second Line	:
City	:	LITTLE FALLS
State	:	MN
Zip	:	56345-3038
Country	:	US
Telephone Number	:	320-264-8885
Fax Number	:

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

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	03/02/2023

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