Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 0023973 | CO |
NPI | 1003406182 |
---|---|
Provider Name | Danielle Ernst |
First Address | Lakewood, CO 80226-5028 |
Second Address | Lakewood, CO 80226-5028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2021 |
Last Update Date | 21/01/2021 |