MEDICARE: MS. JATANYA LYNN CRAWFORD-ANTL LMT, NCTMB

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

General Provider Information

NPI Number	:	1669686036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JATANYA LYNN CRAWFORD-ANTL LMT, NCTMB

Provider Business Mailing Address
First Line	:	3675 BRISBANE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4109
Country	:	US
Telephone Number	:	719-492-8743
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 W COLORADO AVE STE 101-A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-3863
Country	:	US
Telephone Number	:	719-492-8743
Fax Number	:

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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