MEDICARE: TRACY JEAN KNIGHT 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	33.022479	OH

General Provider Information

NPI Number	:	1275067621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY JEAN KNIGHT LMT

Provider Business Mailing Address
First Line	:	1647 GREENE LAKE DR
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-1534
Country	:	US
Telephone Number	:	937-329-1067
Fax Number	:

Provider Business Practice Location Address
First Line	:	1647 GREENE LAKE DR
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-1534
Country	:	US
Telephone Number	:	937-329-1067
Fax Number	:

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

Provider Enumeration Date	:	04/12/2017
Last Update Date	:	04/12/2017

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