MEDICARE: GARY JAEGER LM

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	:	1598897357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY JAEGER LM

Provider Business Mailing Address
First Line	:	4110 STONE WAY N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 STONE WAY N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8000
Country	:	US
Telephone Number	:	206-612-6878
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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Directions to “ GARY JAEGER LM” Practice Location

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