MEDICARE: JENNIFER MEYNARDIE MT, MASSAGE THERAPY

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	MT.0020996	CO

General Provider Information

NPI Number	:	1104324995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MEYNARDIE MT, MASSAGE THERAPY

Provider Business Mailing Address
First Line	:	5745 LINGER WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3587
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5426 N ACADEMY BLVD STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3686
Country	:	US
Telephone Number	:	719-357-6652
Fax Number	:

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

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	01/26/2018

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