MEDICARE: LAURA JANE WEBBER RMT, CNMT

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	172M00000X	Mechanotherapist	11259	CO

General Provider Information

NPI Number	:	1952604076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JANE WEBBER RMT, CNMT

Provider Business Mailing Address
First Line	:	3135 SPRINGMEADOW DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3740
Country	:	US
Telephone Number	:	719-660-0368
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 W COLORADO AVE STE 103A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-3863
Country	:	US
Telephone Number	:	719-660-0388
Fax Number	:

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

Provider Enumeration Date	:	12/10/2010
Last Update Date	:	12/10/2010

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