Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT-001303 | CO |
NPI | 1013350594 |
---|---|
Provider Name | Danae Beaudette |
First Address | Arvada, CO 80002-3803 |
Second Address | Arvada, CO 80002-3803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2013 |
Last Update Date | 15/04/2013 |