MEDICARE: ELIZABETH GILLESPIE M.T.

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	174400000X	Specialist	MT.0015899	CO
2	225700000X	Massage Therapist	MT.0015899	CO

General Provider Information

NPI Number	:	1952792434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH GILLESPIE M.T.

Provider Business Mailing Address
First Line	:	4689 SOUTH MARIPOSA DRIVE
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80110-5512
Country	:	US
Telephone Number	:	303-916-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	6972 SOUTH VINE STREET, SUITE 360
Second Line	:	SOLA SALON SUITES, STUDIO #5
City	:	CENTENNIAL
State	:	CO
Zip	:	80122-3269
Country	:	US
Telephone Number	:	303-916-4222
Fax Number	:

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

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	08/23/2018

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