MEDICARE: KATY MENDES ATC, CMT

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	2255A2300X	Athletic Trainer
2	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1831386895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATY MENDES ATC, CMT

Provider Business Mailing Address
First Line	:	PO BOX 6344
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-0344
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	814 FOREST ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-4408
Country	:	US
Telephone Number	:	720-350-3283
Fax Number	:

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

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	11/06/2007

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