MEDICARE: JILL M BEDARD LMBT

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	21409	CO

General Provider Information

NPI Number	:	1689171449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL M BEDARD LMBT

Provider Business Mailing Address
First Line	:	107 W 29TH ST STE 100
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-2200
Country	:	US
Telephone Number	:	970-663-6142
Fax Number	:	970-635-3087

Provider Business Practice Location Address
First Line	:	2211 S COLLEGE AVE STE 300
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1491
Country	:	US
Telephone Number	:	970-663-6142
Fax Number	:	970-488-2850

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

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	04/09/2018

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