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NPI Code Detail

MEDICARE: TEAGAN LUCKEY

MEDICARE: TEAGAN LUCKEY
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
1225700000XMassage TherapistMA60801307WA

General Provider Information

NPI Number : 1144791146
Entity Type Code : Individual
Provider Name (Legal Business Name) : TEAGAN LUCKEY
Provider Business Mailing Address
First Line : 726 N MCDONALD RD APT 112
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99216-2949
Country : US
Telephone Number : 208-699-8364
Fax Number :
Provider Business Practice Location Address
First Line : 2207 N MOLTER RD STE 250
Second Line :
City : LIBERTY LAKE
State : WA
Zip : 99019-7582
Country : US
Telephone Number : 208-699-8364
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2018
Last Update Date : 12/17/2018

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Directions to “ TEAGAN LUCKEY ” Practice Location

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