MEDICARE: DUSTY V KURT LMT

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	15586	OR

General Provider Information

NPI Number	:	1669722724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTY V KURT LMT

Provider Business Mailing Address
First Line	:	1141 SE RUMMEL ST
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-6364
Country	:	US
Telephone Number	:	503-985-9417
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 S TRADE ST STE 105
Second Line	:
City	:	AMITY
State	:	OR
Zip	:	97101-1500
Country	:	US
Telephone Number	:	503-985-9417
Fax Number	:

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

Provider Enumeration Date	:	09/17/2012
Last Update Date	:	10/15/2019

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