MEDICARE: MR. BRAD WHITWORTH 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.0021547	CO

General Provider Information

NPI Number	:	1770060592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRAD WHITWORTH LMT

Provider Business Mailing Address
First Line	:	4400 S QUEBEC ST APT C208
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-2667
Country	:	US
Telephone Number	:	303-619-3016
Fax Number	:

Provider Business Practice Location Address
First Line	:	2570 S COLORADO BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-5909
Country	:	US
Telephone Number	:	720-609-7033
Fax Number	:

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

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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