MEDICARE: KRYSTYN WHALEY

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	0000611	CO

General Provider Information

NPI Number	:	1942623418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTYN WHALEY

Provider Business Mailing Address
First Line	:	1675 FILLMORE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-1513
Country	:	US
Telephone Number	:	208-724-5853
Fax Number	:

Provider Business Practice Location Address
First Line	:	1675 FILLMORE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-1513
Country	:	US
Telephone Number	:	208-724-5853
Fax Number	:

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

Provider Enumeration Date	:	02/03/2014
Last Update Date	:	02/03/2014

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