MEDICARE: LAURIEN MOES RMT, CNMT

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	174400000X	Specialist	MT-11574	CO

General Provider Information

NPI Number	:	1699064204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIEN MOES RMT, CNMT

Provider Business Mailing Address
First Line	:	7075 CAMPUS DR STE 102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-6524
Country	:	US
Telephone Number	:	703-801-5173
Fax Number	:	719-265-1752

Provider Business Practice Location Address
First Line	:	7075 CAMPUS DR STE 102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-6524
Country	:	US
Telephone Number	:	703-801-5173
Fax Number	:	719-265-1752

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

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	04/04/2011

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