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NPI Code Detail

MEDICARE: TIMOTHY TERRELL CORNER JR. MASSAGE THERAPIST

MEDICARE: TIMOTHY TERRELL CORNER JR. MASSAGE THERAPIST
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 TherapistMT.0004572CO

General Provider Information

NPI Number : 1184430076
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY TERRELL CORNER JR. MASSAGE THERAPIST
Provider Business Mailing Address
First Line : 7931 GOLDENRAY PL
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80908-5076
Country : US
Telephone Number : 719-304-1932
Fax Number :
Provider Business Practice Location Address
First Line : 6015 LEHMAN DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-3432
Country : US
Telephone Number : 719-304-1932
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2024
Last Update Date : 12/05/2024

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