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NPI Code Detail

MEDICARE: ELIZABETH JEAN SHEPHARD LMT

MEDICARE:   ELIZABETH JEAN SHEPHARD  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
1225700000XMassage TherapistMT.0014703CO

General Provider Information

NPI Number : 1023454816
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH JEAN SHEPHARD LMT
Provider Business Mailing Address
First Line : 1170 E 5TH AVE
Second Line :
City : DURANGO
State : CO
Zip : 81301-5346
Country : US
Telephone Number : 405-714-7662
Fax Number :
Provider Business Practice Location Address
First Line : 1032 1/2 MAIN AVE
Second Line : SUITE 30
City : DURANGO
State : CO
Zip : 81301-5124
Country : US
Telephone Number : 405-714-7662
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2013
Last Update Date : 10/06/2014

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Directions to “ ELIZABETH JEAN SHEPHARD LMT” Practice Location

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