MEDICARE: HEATH SHROYER 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

General Provider Information

NPI Number	:	1134751324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATH SHROYER LMT

Provider Business Mailing Address
First Line	:	2110 W 75TH ST STE E
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-3503
Country	:	US
Telephone Number	:	913-362-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 W 75TH ST STE E
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-3503
Country	:	US
Telephone Number	:	913-362-4800
Fax Number	:

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

Provider Enumeration Date	:	02/06/2020
Last Update Date	:	02/06/2020

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Directions to “ HEATH SHROYER LMT” Practice Location

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