MEDICARE: KRISTY WEST

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.0012172	CO

General Provider Information

NPI Number	:	1679960389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY WEST

Provider Business Mailing Address
First Line	:	12835 CASA DE CAMPO RD
Second Line	:
City	:	PEYTON
State	:	CO
Zip	:	80831-4073
Country	:	US
Telephone Number	:	719-660-3507
Fax Number	:

Provider Business Practice Location Address
First Line	:	1495 GARDEN OF THE GODS RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-9441
Country	:	US
Telephone Number	:	719-260-9797
Fax Number	:

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

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	04/20/2015

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