MEDICARE: KAREN LEE 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	MT.0017716	CO

General Provider Information

NPI Number	:	1699145748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LEE LMT

Provider Business Mailing Address
First Line	:	2532 PONY CLUB LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-3198
Country	:	US
Telephone Number	:	719-310-7977
Fax Number	:	719-960-2240

Provider Business Practice Location Address
First Line	:	2120 ACADEMY CIR STE F
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1674
Country	:	US
Telephone Number	:	719-310-7977
Fax Number	:	719-960-2240

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

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	02/13/2024

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