MEDICARE: JANET LYNNE SHIPMAN 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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1881994697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET LYNNE SHIPMAN CMT

Provider Business Mailing Address
First Line	:	1010 GRAND AVE
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3604
Country	:	US
Telephone Number	:	970-366-6412
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 GRAND AVE
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3604
Country	:	US
Telephone Number	:	970-366-6412
Fax Number	:

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

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	10/26/2010

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