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NPI Code Detail

MEDICARE: TERESA LOUISE CROW LMP

MEDICARE:   TERESA LOUISE CROW  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
1225700000XMassage TherapistMA00018244WA

General Provider Information

NPI Number : 1508071689
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA LOUISE CROW LMP
Provider Business Mailing Address
First Line : PO BOX 2282
Second Line :
City : MOSES LAKE
State : WA
Zip : 98837-0682
Country : US
Telephone Number : 509-989-5029
Fax Number :
Provider Business Practice Location Address
First Line : 310 S BALSAM ST STE B
Second Line :
City : MOSES LAKE
State : WA
Zip : 98837-1763
Country : US
Telephone Number : 509-989-5029
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2007
Last Update Date : 06/09/2011

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Directions to “ TERESA LOUISE CROW LMP” Practice Location

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