MEDICARE: UNIFIED MANUAL THERAPY INC.

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	172M00000X	Mechanotherapist
2	225C00000X	Rehabilitation Counselor
3	225700000X	Massage Therapist	MT 0006487	CO

General Provider Information

NPI Number	:	1710398722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIFIED MANUAL THERAPY INC.

Provider Business Mailing Address
First Line	:	1776 S JACKSON ST STE 614
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3819
Country	:	US
Telephone Number	:	303-332-6275
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 S JACKSON ST STE 614
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3819
Country	:	US
Telephone Number	:	303-332-6275
Fax Number	:

Authorized Official
Title or Position	:	MANUAL THERAPIST
Name	:	JOSEPH SHINDOLL
Credential	:	M.T.
Telephone Number	:	303-332-6275

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	05/13/2014

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