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NPI Code Detail

MEDICARE: MARIAH TRACY ANN WOOD

MEDICARE: MARIAH TRACY ANN WOOD
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
1225700000XMassage TherapistMT.0023540CO

General Provider Information

NPI Number : 1336878750
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAH TRACY ANN WOOD
Provider Business Mailing Address
First Line : 697 1675 RD
Second Line :
City : DELTA
State : CO
Zip : 81416-3462
Country : US
Telephone Number : 970-985-1491
Fax Number : 970-546-0092
Provider Business Practice Location Address
First Line : 697 1675 RD
Second Line :
City : DELTA
State : CO
Zip : 81416-3462
Country : US
Telephone Number : 970-985-1491
Fax Number : 970-546-0092
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2022
Last Update Date : 06/09/2022

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Directions to “ MARIAH TRACY ANN WOOD ” Practice Location

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