MEDICARE: KENNETH MCGRATH 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	27286	OR

General Provider Information

NPI Number	:	1710691753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH MCGRATH LMT

Provider Business Mailing Address
First Line	:	1100 IVY LN
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-3236
Country	:	US
Telephone Number	:	503-702-9941
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 S GRAPE ST
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-3147
Country	:	US
Telephone Number	:	503-702-9941
Fax Number	:

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

Provider Enumeration Date	:	01/12/2023
Last Update Date	:	01/12/2023

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