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NPI Code Detail

MEDICARE: JACKIE PADGETT LMT

MEDICARE: JACKIE PADGETT 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
1225700000XMassage Therapist9330CO

General Provider Information

NPI Number : 1073914537
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKIE PADGETT LMT
Provider Business Mailing Address
First Line : 5597 E MANSFIELD AVE
Second Line :
City : DENVER
State : CO
Zip : 80237-1069
Country : US
Telephone Number : 303-758-4185
Fax Number :
Provider Business Practice Location Address
First Line : 2401 S DOWNING ST
Second Line :
City : DENVER
State : CO
Zip : 80210-5811
Country : US
Telephone Number : 303-733-2727
Fax Number : 303-733-2929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2014
Last Update Date : 09/15/2014

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Directions to “ JACKIE PADGETT LMT” Practice Location

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