MEDICARE: CHANDRA WALMSLEY 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	269755	KY

General Provider Information

NPI Number	:	1356093165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDRA WALMSLEY LMT

Provider Business Mailing Address
First Line	:	866 HOPEWELL RD
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-9158
Country	:	US
Telephone Number	:	859-421-8469
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 RICHMOND RD STE 210
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-1213
Country	:	US
Telephone Number	:	859-421-8469
Fax Number	:

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

Provider Enumeration Date	:	01/23/2022
Last Update Date	:	01/23/2022

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