MEDICARE: SAVANNA LOEWEN 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.0022901	CO

General Provider Information

NPI Number	:	1821629627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNA LOEWEN LMT

Provider Business Mailing Address
First Line	:	4223 S MASON ST STE B
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3048
Country	:	US
Telephone Number	:	970-673-0892
Fax Number	:

Provider Business Practice Location Address
First Line	:	4223 S MASON ST STE B
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3048
Country	:	US
Telephone Number	:	970-673-0892
Fax Number	:

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

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	01/30/2020

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Directions to “ SAVANNA LOEWEN LMT” Practice Location

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