MEDICARE: MICHELLE CASTOR

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.0014127	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT.0014127	OTHER	CO	STATE OF COLORADO - MASSAGE THERAPIST LICENSE

General Provider Information

NPI Number	:	1851810758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE CASTOR

Provider Business Mailing Address
First Line	:	418 LOWELL BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 W ARKANSAS AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80223-3225
Country	:	US
Telephone Number	:	720-583-3614
Fax Number	:

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

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	09/12/2017

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Directions to “ MICHELLE CASTOR ” Practice Location

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