MEDICARE: ANGIE BODE

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	0002605	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT.00002605	OTHER	CO	STATE LICENSE

General Provider Information

NPI Number	:	1467874735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGIE BODE

Provider Business Mailing Address
First Line	:	102 S TEJON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 S TEJON ST
Second Line	:	102A
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2231
Country	:	US
Telephone Number	:	719-237-5690
Fax Number	:

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

Provider Enumeration Date	:	01/06/2014
Last Update Date	:	01/07/2014

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Directions to “ ANGIE BODE ” Practice Location

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