MEDICARE: MRS. THERESA ANN GLASSCOCK L.M.P.

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	MA00007675	WA

General Provider Information

NPI Number	:	1871629063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. THERESA ANN GLASSCOCK L.M.P.

Provider Business Mailing Address
First Line	:	2009 191ST AVENUE COURT KP S
Second Line	:
City	:	LAKEBAY
State	:	WA
Zip	:	98349-9444
Country	:	US
Telephone Number	:	253-884-9473
Fax Number	:

Provider Business Practice Location Address
First Line	:	3610 GRANDVIEW ST
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1135
Country	:	US
Telephone Number	:	253-853-1900
Fax Number	:	253-853-1808

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

Provider Enumeration Date	:	02/24/2007
Last Update Date	:	07/08/2007

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