Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT.0019837 | CO |
NPI | 1013454610 |
---|---|
Provider Name | Brenda A Maloukis |
First Address | Colorado Springs, CO 80911-3828 |
Second Address | Colorado Springs, CO 80911-3828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2017 |
Last Update Date | 21/01/2017 |