MEDICARE: CANDICE GALE 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
1	225700000X	Massage Therapist	MT.0016454	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT.0016454	OTHER	CO	DORA LICENSE

General Provider Information

NPI Number	:	1104401991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE GALE LMT

Provider Business Mailing Address
First Line	:	3835 OSAGE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-2656
Country	:	US
Telephone Number	:	303-600-8325
Fax Number	:

Provider Business Practice Location Address
First Line	:	3835 OSAGE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-2656
Country	:	US
Telephone Number	:	303-600-8325
Fax Number	:

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

Provider Enumeration Date	:	03/12/2021
Last Update Date	:	03/12/2021

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Directions to “ CANDICE GALE LMT” Practice Location

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