MEDICARE: MRS. AMY J ROSE RN, LMT, CNMT

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	MT-8840	CO
2	163WM1400X	Nurse Massage Therapist (NMT)	RN.1623859	CO

General Provider Information

NPI Number	:	1457618340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY J ROSE RN, LMT, CNMT

Provider Business Mailing Address
First Line	:	955 N GREENWOOD ST
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2927
Country	:	US
Telephone Number	:	719-256-0797
Fax Number	:	719-285-0781

Provider Business Practice Location Address
First Line	:	955 N GREENWOOD ST
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2927
Country	:	US
Telephone Number	:	719-256-0797
Fax Number	:

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

Provider Enumeration Date	:	04/16/2012
Last Update Date	:	10/01/2024

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