MEDICARE: JUDY MAXFIELD MT

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	T9106014	CO

General Provider Information

NPI Number	:	1083735385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY MAXFIELD MT

Provider Business Mailing Address
First Line	:	7249 SECREST CT
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80007-7622
Country	:	US
Telephone Number	:	303-263-0802
Fax Number	:

Provider Business Practice Location Address
First Line	:	7050 W 120TH AVE UNIT 104
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80020-7604
Country	:	US
Telephone Number	:	303-263-0802
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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Directions to “ JUDY MAXFIELD MT” Practice Location

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