MEDICARE: MR. BRUCE BLOWERS L.M.T.

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	0523	NM

General Provider Information

NPI Number	:	1023434149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE BLOWERS L.M.T.

Provider Business Mailing Address
First Line	:	7810 MENAUL BLVD. N.E.
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110
Country	:	US
Telephone Number	:	505-227-4821
Fax Number	:

Provider Business Practice Location Address
First Line	:	7810 MENAUL BLVD. N.E.
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110
Country	:	US
Telephone Number	:	505-227-4821
Fax Number	:

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

Provider Enumeration Date	:	03/13/2014
Last Update Date	:	03/13/2014

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