MEDICARE: JEREMY AARON UNDERWOOD 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.0019843	CO

General Provider Information

NPI Number	:	1891263562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY AARON UNDERWOOD LMT

Provider Business Mailing Address
First Line	:	9045 E GIRARD AVE APT 54
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-5026
Country	:	US
Telephone Number	:	720-808-0309
Fax Number	:

Provider Business Practice Location Address
First Line	:	9045 E GIRARD AVE APT 54
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-5026
Country	:	US
Telephone Number	:	720-808-0309
Fax Number	:

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

Provider Enumeration Date	:	11/11/2018
Last Update Date	:	11/11/2018

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