MEDICARE: ERIKA BENNETT CRIPE LMT

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	MT0021497	CO

General Provider Information

NPI Number	:	1154812642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA BENNETT CRIPE LMT

Provider Business Mailing Address
First Line	:	697 JASPER DR
Second Line	:
City	:	FRUITA
State	:	CO
Zip	:	81521-8314
Country	:	US
Telephone Number	:	405-255-1279
Fax Number	:

Provider Business Practice Location Address
First Line	:	2231 N 7TH ST STE 14
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-7434
Country	:	US
Telephone Number	:	970-640-7682
Fax Number	:

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

Provider Enumeration Date	:	05/21/2018
Last Update Date	:	05/21/2018

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