MEDICARE: MS. JESSICA L LIU-KEBAILI 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	R01808	MD
2	225700000X	Massage Therapist	M	DC
3	225700000X	Massage Therapist	0019014538	VA
4	225700000X	Massage Therapist	MT2020	DC

General Provider Information

NPI Number	:	1053768135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA L LIU-KEBAILI LMT

Provider Business Mailing Address
First Line	:	13 JERMAE STREET
Second Line	:
City	:	THURMONT
State	:	MD
Zip	:	21788
Country	:	US
Telephone Number	:	240-440-1094
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 WEEPING WILLOW CT APT 42
Second Line	:
City	:	ASPEN HILL
State	:	MD
Zip	:	20906-2567
Country	:	US
Telephone Number	:	240-440-1094
Fax Number	:

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

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	10/02/2024

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