MEDICARE: MS. CAROL VICARI CMT

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		CO

General Provider Information

NPI Number	:	1609026236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL VICARI CMT

Provider Business Mailing Address
First Line	:	6947 HIGHWAY 73 STE L
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-6579
Country	:	US
Telephone Number	:	303-816-4016
Fax Number	:

Provider Business Practice Location Address
First Line	:	6947 HIGHWAY 73 STE L
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-6579
Country	:	US
Telephone Number	:	303-816-4016
Fax Number	:

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

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	09/18/2008

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