Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT-7549 | CO |
NPI | 1003043126 |
---|---|
Provider Name | Ingrid Hamblin |
First Address | Aurora, CO 80011-6731 |
Second Address | Aurora, CO 80011-6731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 16/06/2009 |