MEDICARE: LIANNA QUILLEN RMT

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	8444	CO

General Provider Information

NPI Number	:	1083992143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANNA QUILLEN RMT

Provider Business Mailing Address
First Line	:	4101 E LOUISIANA AVE
Second Line	:	#205
City	:	DENVER
State	:	CO
Zip	:	80246-3431
Country	:	US
Telephone Number	:	720-281-9355
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 E LOUISIANA AVE
Second Line	:	#205
City	:	DENVER
State	:	CO
Zip	:	80246-3431
Country	:	US
Telephone Number	:	720-281-9355
Fax Number	:

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

Provider Enumeration Date	:	07/23/2011
Last Update Date	:	07/23/2011

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