MEDICARE: ALEXANDRA MARIA NYMAN 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.0023450	CO

General Provider Information

NPI Number	:	1821769787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA MARIA NYMAN LMT

Provider Business Mailing Address
First Line	:	5959 BALLESTEROS CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8876
Country	:	US
Telephone Number	:	503-442-4417
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 MIDPOINT DR STE 100
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4448
Country	:	US
Telephone Number	:	503-442-4417
Fax Number	:

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

Provider Enumeration Date	:	09/21/2021
Last Update Date	:	09/21/2021

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