MEDICARE: ADVANCED MEDICAL MASSAGE INC

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		CO

General Provider Information

NPI Number	:	1023223146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL MASSAGE INC

Provider Business Mailing Address
First Line	:	2020 W COLORADO AVE
Second Line	:	STE 101
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904
Country	:	US
Telephone Number	:	719-634-0708
Fax Number	:	719-634-2392

Provider Business Practice Location Address
First Line	:	2020 W COLORADO AVE
Second Line	:	STE 101
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-3882
Country	:	US
Telephone Number	:	719-634-0708
Fax Number	:	719-634-2392

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BONNIE THOMPSON
Credential	:	LMT
Telephone Number	:	719-634-0708

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	08/22/2020

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