MEDICARE: MRS. KRISTI ASTRID POWELL

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	MT001972	GA

General Provider Information

NPI Number	:	1376705277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTI ASTRID POWELL

Provider Business Mailing Address
First Line	:	PO BOX 665
Second Line	:
City	:	CLERMONT
State	:	GA
Zip	:	30527-0641
Country	:	US
Telephone Number	:	678-617-4992
Fax Number	:

Provider Business Practice Location Address
First Line	:	1709 CLEVELAND HWY
Second Line	:	BODYWORKS
City	:	GAINESVILLE
State	:	GA
Zip	:	30501
Country	:	US
Telephone Number	:	770-532-2778
Fax Number	:

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

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	07/01/2008

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