MEDICARE: HEIDE MOORE ELSWORTH LMT, CNMT, CNB

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	14181	CO

General Provider Information

NPI Number	:	1356531917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDE MOORE ELSWORTH LMT, CNMT, CNB

Provider Business Mailing Address
First Line	:	3570 KNOLL LN APT 127
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-8552
Country	:	US
Telephone Number	:	719-460-4647
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 W COLORADO AVE STE 103
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-3863
Country	:	US
Telephone Number	:	719-460-4647
Fax Number	:

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

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	07/21/2022

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