MEDICARE: KYRA LISBETH WERK

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	88603	CA

General Provider Information

NPI Number	:	1649122136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYRA LISBETH WERK

Provider Business Mailing Address
First Line	:	1009 S HARBOR BLVD SPC 72
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92805-5585
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19015 BUSHARD ST
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-2431
Country	:	US
Telephone Number	:	714-965-5350
Fax Number	:

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

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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