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NPI Code Detail

MEDICARE: JUSTIN CLINE LMT

MEDICARE: JUSTIN CLINE 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
1225700000XMassage Therapist169404KY

General Provider Information

NPI Number : 1710435060
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN CLINE LMT
Provider Business Mailing Address
First Line : 445 DARBY CREEK RD
Second Line : APT. B
City : LEXINGTON
State : KY
Zip : 40509-1299
Country : US
Telephone Number : 859-398-9765
Fax Number :
Provider Business Practice Location Address
First Line : 168 E REYNOLDS RD STE 150
Second Line :
City : LEXINGTON
State : KY
Zip : 40517-1360
Country : US
Telephone Number : 859-368-8226
Fax Number : 859-368-8226
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2016
Last Update Date : 01/03/2018

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