MEDICARE: MS. SUSAN DIANE PALUMBO LMT, CNMT

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.0018268	CO

General Provider Information

NPI Number	:	1528591922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN DIANE PALUMBO LMT, CNMT

Provider Business Mailing Address
First Line	:	2704 WREN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1152
Country	:	US
Telephone Number	:	719-426-7010
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 S CASCADE AVE
Second Line	:	SUITE 103
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4039
Country	:	US
Telephone Number	:	719-426-7010
Fax Number	:

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

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	04/04/2017

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