MEDICARE: CHRISTINA L. KOEHLER L.M.P.

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	MA000012841	WA

General Provider Information

NPI Number	:	1104005040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA L. KOEHLER L.M.P.

Provider Business Mailing Address
First Line	:	PO BOX 545
Second Line	:
City	:	GRANGEVILLE
State	:	ID
Zip	:	83530-0545
Country	:	US
Telephone Number	:	208-983-6317
Fax Number	:

Provider Business Practice Location Address
First Line	:	617 W NORTH ST
Second Line	:
City	:	GRANGEVILLE
State	:	ID
Zip	:	83530-1239
Country	:	US
Telephone Number	:	208-983-6317
Fax Number	:

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

Provider Enumeration Date	:	10/28/2007
Last Update Date	:	04/25/2009

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