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NPI Code Detail

MEDICARE: LAUREN REESE CMT

MEDICARE: LAUREN REESE CMT
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 TherapistMT21304814IN

General Provider Information

NPI Number : 1083081400
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN REESE CMT
Provider Business Mailing Address
First Line : 6109 SHADOW RIDGE PL
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-4297
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5111 N BEND DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-1753
Country : US
Telephone Number : 260-436-8807
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2015
Last Update Date : 09/02/2015

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