MEDICARE: PREFFERED MASSAGE OF INT'L FALLS

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

General Provider Information

NPI Number	:	1124142310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFFERED MASSAGE OF INT'L FALLS

Provider Business Mailing Address
First Line	:	1322 3RD ST STE 4
Second Line	:
City	:	INTL FALLS
State	:	MN
Zip	:	56649-2129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 3RD ST STE 4
Second Line	:
City	:	INTL FALLS
State	:	MN
Zip	:	56649-2129
Country	:	US
Telephone Number	:	218-283-2243
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LORI POTTER
Credential	:
Telephone Number	:	218-283-2243

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	06/26/2008

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Directions to “PREFFERED MASSAGE OF INT'L FALLS ” Practice Location

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