MEDICARE: CATE SMOCK

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	0008331	CO

General Provider Information

NPI Number	:	1205220092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATE SMOCK

Provider Business Mailing Address
First Line	:	PO BOX 932
Second Line	:
City	:	PAGOSA SPRINGS
State	:	CO
Zip	:	81147-0932
Country	:	US
Telephone Number	:	970-903-9492
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 E 3RD AVE
Second Line	:	104
City	:	DURANGO
State	:	CO
Zip	:	81301-5255
Country	:	US
Telephone Number	:	970-903-9492
Fax Number	:

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

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	03/19/2015

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Directions to “ CATE SMOCK ” Practice Location

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