MEDICARE: ALLEN J TEFFT 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.0021829	CO

General Provider Information

NPI Number	:	1760127492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLEN J TEFFT LMT

Provider Business Mailing Address
First Line	:	367 HOLLADAY CT
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-3326
Country	:	US
Telephone Number	:	970-215-5182
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 CLEVELAND AVE STE E
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-3835
Country	:	US
Telephone Number	:	970-215-5182
Fax Number	:

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

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	04/27/2022

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