MEDICARE: MRS. BRIGETTE S SHIVELEY 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	MT.0008030	CO

General Provider Information

NPI Number	:	1417780081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIGETTE S SHIVELEY LMT

Provider Business Mailing Address
First Line	:	8762 TRANQUIL KNOLL LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4154
Country	:	US
Telephone Number	:	719-237-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	8762 TRANQUIL KNOLL LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4154
Country	:	US
Telephone Number	:	719-237-0404
Fax Number	:

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

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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