MEDICARE: MRS. TERESA LEAH LUGINBILL CMT

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	CERTIFICATE	MN

General Provider Information

NPI Number	:	1336853795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA LEAH LUGINBILL CMT

Provider Business Mailing Address
First Line	:	46659 BEACH RD
Second Line	:
City	:	HARRIS
State	:	MN
Zip	:	55032-3801
Country	:	US
Telephone Number	:	651-343-2127
Fax Number	:

Provider Business Practice Location Address
First Line	:	46659 BEACH RD
Second Line	:
City	:	HARRIS
State	:	MN
Zip	:	55032-3801
Country	:	US
Telephone Number	:	651-343-2127
Fax Number	:

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

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	01/10/2023

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