MEDICARE: MS. SUMMER EARTHSONG NCTMB

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	172M00000X	Mechanotherapist

General Provider Information

NPI Number	:	1619117710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUMMER EARTHSONG NCTMB

Provider Business Mailing Address
First Line	:	1133 PATTERSON RD STE 3
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-8848
Country	:	US
Telephone Number	:	970-243-1388
Fax Number	:	970-243-1572

Provider Business Practice Location Address
First Line	:	1133 PATTERSON RD STE 3
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-8848
Country	:	US
Telephone Number	:	970-243-1388
Fax Number	:	970-243-1572

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

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	03/02/2009

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