MEDICARE: REID MATTHEW POPP LMP

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	MA 60296203	WA

General Provider Information

NPI Number	:	1427492750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REID MATTHEW POPP LMP

Provider Business Mailing Address
First Line	:	13701 E SPRAGUE AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-0811
Country	:	US
Telephone Number	:	509-922-5585
Fax Number	:	509-927-7336

Provider Business Practice Location Address
First Line	:	13701 E SPRAGUE AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-0811
Country	:	US
Telephone Number	:	509-922-5585
Fax Number	:	509-927-7336

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

Provider Enumeration Date	:	04/17/2013
Last Update Date	:	03/21/2016

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