Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 0017128 | CO |
NPI | 1013384940 |
---|---|
Provider Name | Elisa Brett Safran |
First Address | Boulder, CO 80303-1004 |
Second Address | Boulder, CO 80303-1004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2015 |
Last Update Date | 26/08/2015 |