MEDICARE: NANCY HUCKEBY-GONZALEZ 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
1	225700000X	Massage Therapist	MT.0014624	CO

General Provider Information

NPI Number	:	1265949036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY HUCKEBY-GONZALEZ MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	7446 INDIAN WELLS WAY
Second Line	:
City	:	LONE TREE
State	:	CO
Zip	:	80124-4211
Country	:	US
Telephone Number	:	571-449-1779
Fax Number	:

Provider Business Practice Location Address
First Line	:	2570 S COLORADO BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-5909
Country	:	US
Telephone Number	:	720-277-7018
Fax Number	:	720-277-7018

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

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	01/03/2018

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