MEDICARE: MRS. MELISSA ANNE MADSEN 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	712207	CO

General Provider Information

NPI Number	:	1730392275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA ANNE MADSEN LMT

Provider Business Mailing Address
First Line	:	1205 WINTERHALL PT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-9602
Country	:	US
Telephone Number	:	719-244-7850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 WINTERHALL PT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-9602
Country	:	US
Telephone Number	:	719-244-7850
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	03/18/2009

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