MEDICARE: MS. SUSAN MARGARET BOUGHTON 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	2606	CO

General Provider Information

NPI Number	:	1568750313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN MARGARET BOUGHTON LMT

Provider Business Mailing Address
First Line	:	5067 S EVANSTON ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-2203
Country	:	US
Telephone Number	:	303-521-4632
Fax Number	:

Provider Business Practice Location Address
First Line	:	5067 S EVANSTON ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-2203
Country	:	US
Telephone Number	:	303-521-4632
Fax Number	:

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

Provider Enumeration Date	:	07/14/2011
Last Update Date	:	07/14/2011

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