MEDICARE: MR. REATHEL EARL GEARY III 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	023513	OR

General Provider Information

NPI Number	:	1912422429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. REATHEL EARL GEARY III LMT

Provider Business Mailing Address
First Line	:	1957 LAWRENCE ST
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-2649
Country	:	US
Telephone Number	:	541-686-4461
Fax Number	:

Provider Business Practice Location Address
First Line	:	3575 DONALD ST STE 630
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-4775
Country	:	US
Telephone Number	:	541-525-0191
Fax Number	:

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

Provider Enumeration Date	:	08/04/2017
Last Update Date	:	07/21/2022

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