MEDICARE: RICHARD JOSEPH RYCZEK 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	MT.0025336	CO

General Provider Information

NPI Number	:	1982329124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD JOSEPH RYCZEK LMT

Provider Business Mailing Address
First Line	:	1271 S WARD CT
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-3839
Country	:	US
Telephone Number	:	704-467-7496
Fax Number	:

Provider Business Practice Location Address
First Line	:	1271 S WARD CT
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-3839
Country	:	US
Telephone Number	:	704-467-7496
Fax Number	:

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

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	10/10/2022

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