MEDICARE: MISS MARIETTA J KERBY CMT

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		CO

General Provider Information

NPI Number	:	1457412843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIETTA J KERBY CMT

Provider Business Mailing Address
First Line	:	1244 S WADSWORTH BLVD
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-5437
Country	:	US
Telephone Number	:	303-936-6646
Fax Number	:	501-634-7692

Provider Business Practice Location Address
First Line	:	1244 S WADSWORTH BLVD
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-5437
Country	:	US
Telephone Number	:	303-936-6646
Fax Number	:	501-634-7692

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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