Provider Demographics
NPI:1255045068
Name:HIGHSMITH, MEGAN (LMT/C-MLD/MMP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HIGHSMITH
Suffix:
Gender:F
Credentials:LMT/C-MLD/MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 COLONIAL AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1338
Mailing Address - Country:US
Mailing Address - Phone:757-325-0631
Mailing Address - Fax:
Practice Address - Street 1:2607 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1338
Practice Address - Country:US
Practice Address - Phone:757-325-0631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019014583225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist