MEDICARE: LYMPHWORKS, LLC

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

General Provider Information

NPI Number	:	1528204013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYMPHWORKS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 796
Second Line	:
City	:	FT. COLLINS
State	:	CO
Zip	:	80522-0796
Country	:	US
Telephone Number	:	970-222-9421
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 STONEY HILL DRIVE
Second Line	:	SUITE A
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1372
Country	:	US
Telephone Number	:	970-222-9421
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CAROL JOY MCDANIEL
Credential	:	LMT HTCP, CRMP
Telephone Number	:	970-222-9421

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	11/17/2016

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Directions to “LYMPHWORKS, LLC ” Practice Location

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