MEDICARE: MS. LINDSAY E BRAZIL 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	130355	CO

General Provider Information

NPI Number	:	1184896474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDSAY E BRAZIL LMT

Provider Business Mailing Address
First Line	:	630 PARADISE LANE
Second Line	:
City	:	COLO SPRINGS
State	:	CO
Zip	:	80904-1738
Country	:	US
Telephone Number	:	719-630-0299
Fax Number	:

Provider Business Practice Location Address
First Line	:	1526 S TEJON
Second Line	:
City	:	COLO SPRINGS
State	:	CO
Zip	:	80906-2214
Country	:	US
Telephone Number	:	719-630-0299
Fax Number	:

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

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	03/27/2008

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