MEDICARE: THE POTTER'S HANDS MASSAGE THERAPY, LLC

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.0012377	CO

General Provider Information

NPI Number	:	1912456518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE POTTER'S HANDS MASSAGE THERAPY, LLC

Provider Business Mailing Address
First Line	:	3585 DARKWOOD PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-1611
Country	:	US
Telephone Number	:	719-930-4504
Fax Number	:

Provider Business Practice Location Address
First Line	:	3585 DARKWOOD PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-1611
Country	:	US
Telephone Number	:	719-930-4504
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MRS. MELISSA WEBB
Credential	:	LMT
Telephone Number	:	719-930-4504

Provider Enumeration Date	:	09/25/2016
Last Update Date	:	09/25/2016

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