MEDICARE: JORDAN CROGAN 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	60711330	WA

General Provider Information

NPI Number	:	1912495698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN CROGAN LMT

Provider Business Mailing Address
First Line	:	1306 E GLENCREST DR
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-9729
Country	:	US
Telephone Number	:	509-263-6099
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 W MALLON AVE STE 609
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-2164
Country	:	US
Telephone Number	:	509-263-6099
Fax Number	:

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

Provider Enumeration Date	:	04/27/2018
Last Update Date	:	04/27/2018

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Directions to “ JORDAN CROGAN LMT” Practice Location

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