MEDICARE: GREGORY LEE WORLEY 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	37926	CA

General Provider Information

NPI Number	:	1295324960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY LEE WORLEY LMT

Provider Business Mailing Address
First Line	:	1150 E AMADO RD UNIT 17D2
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-0030
Country	:	US
Telephone Number	:	404-786-7125
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 E AMADO RD UNIT 17D2
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-0030
Country	:	US
Telephone Number	:	404-786-7125
Fax Number	:

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

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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