MEDICARE: KATHRYN GROOMS L.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	MA60175318	WA

General Provider Information

NPI Number	:	1518272988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN GROOMS L.M.P.

Provider Business Mailing Address
First Line	:	9525 4TH ST NE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-1631
Country	:	US
Telephone Number	:	425-397-8313
Fax Number	:	425-397-8330

Provider Business Practice Location Address
First Line	:	9525 4TH ST NE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-1631
Country	:	US
Telephone Number	:	425-397-8313
Fax Number	:	425-397-8330

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

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	08/10/2010

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