MEDICARE: RIAN CELONA GUFAROTTI

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.0005436	CO

General Provider Information

NPI Number	:	1730527037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIAN CELONA GUFAROTTI

Provider Business Mailing Address
First Line	:	4751 N ACADEMY BLVD
Second Line	:	SUITE B
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4268
Country	:	US
Telephone Number	:	719-201-9153
Fax Number	:

Provider Business Practice Location Address
First Line	:	4751 N ACADEMY BLVD
Second Line	:	SUITE B
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4268
Country	:	US
Telephone Number	:	719-201-9153
Fax Number	:

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

Provider Enumeration Date	:	06/07/2013
Last Update Date	:	06/07/2013

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