MEDICARE: DONNA GALVAGNI 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 5409	CO

General Provider Information

NPI Number	:	1558750646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA GALVAGNI LMT

Provider Business Mailing Address
First Line	:	2254 PEAR ST
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-2567
Country	:	US
Telephone Number	:	719-251-3866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 MAIN ST
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-3506
Country	:	US
Telephone Number	:	719-275-0028
Fax Number	:

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

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	01/13/2015

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Directions to “ DONNA GALVAGNI LMT” Practice Location

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