MEDICARE: ANN MARIE KNAPPERT 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	MA60409286	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA60409286	OTHER		LICENSE NUMBER

General Provider Information

NPI Number	:	1225750607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE KNAPPERT LMT

Provider Business Mailing Address
First Line	:	PO BOX 87
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-0087
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 MAIN AVE S
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8215
Country	:	US
Telephone Number	:	425-888-5060
Fax Number	:

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

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	09/13/2022

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