MEDICARE: CARMI ROMONA JORGENSEN L.M.T. M.M.P.

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	MA00004373	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA00004373	OTHER	WA	LMT MMP

General Provider Information

NPI Number	:	1487788527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMI ROMONA JORGENSEN L.M.T. M.M.P.

Provider Business Mailing Address
First Line	:	4416 264TH AVE NE
Second Line	:
City	:	REDMOND
State	:	WA
Zip	:	98053-8729
Country	:	US
Telephone Number	:	425-644-6461
Fax Number	:	425-898-0289

Provider Business Practice Location Address
First Line	:	5611 119TH AVE SE
Second Line	:	SUITE #4
City	:	BELLEVUE
State	:	WA
Zip	:	98006-3799
Country	:	US
Telephone Number	:	425-644-6461
Fax Number	:	425-746-4965

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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