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NPI Code Detail

MEDICARE: DUSTIN ALLEN KNUTSON MASSAGE THERAPIST

MEDICARE:   DUSTIN ALLEN KNUTSON  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 Therapist439875CO

General Provider Information

NPI Number : 1326526575
Entity Type Code : Individual
Provider Name (Legal Business Name) : DUSTIN ALLEN KNUTSON MASSAGE THERAPIST
Provider Business Mailing Address
First Line : 2314 E MONUMENT ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-4819
Country : US
Telephone Number : 719-360-6724
Fax Number :
Provider Business Practice Location Address
First Line : 2314 E MONUMENT ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-4819
Country : US
Telephone Number : 719-360-6724
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2018
Last Update Date : 07/31/2018

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Directions to “ DUSTIN ALLEN KNUTSON MASSAGE THERAPIST” Practice Location

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