MEDICARE: KINA AILIN UEDA 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	172M00000X	Mechanotherapist	MT.0003700	CO
2	225700000X	Massage Therapist	MT.0003700	CO

General Provider Information

NPI Number	:	1003509209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KINA AILIN UEDA LMT

Provider Business Mailing Address
First Line	:	6545 W 44TH AVE
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-4749
Country	:	US
Telephone Number	:	303-902-1676
Fax Number	:

Provider Business Practice Location Address
First Line	:	2416 W 32ND AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3322
Country	:	US
Telephone Number	:	720-524-3431
Fax Number	:

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

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	06/01/2023

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Directions to “ KINA AILIN UEDA LMT” Practice Location

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