MEDICARE: KRISTINA BRISCOE

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	03535	NC

General Provider Information

NPI Number	:	1952786493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA BRISCOE

Provider Business Mailing Address
First Line	:	6012 BAYFIELD PKWY # 193
Second Line	:	SUITE 193
City	:	CONCORD
State	:	NC
Zip	:	28027-7597
Country	:	US
Telephone Number	:	704-266-3531
Fax Number	:

Provider Business Practice Location Address
First Line	:	18809 W CATAWBA AVE # 204-E
Second Line	:	204-E
City	:	CORNELIUS
State	:	NC
Zip	:	28031-5547
Country	:	US
Telephone Number	:	704-266-3531
Fax Number	:

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

Provider Enumeration Date	:	07/27/2015
Last Update Date	:	07/27/2015

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Directions to “ KRISTINA BRISCOE ” Practice Location

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