Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 11906 | CO |
NPI | 1003169442 |
---|---|
Provider Name | Janet Mccann |
First Address | Edgewater, CO 80214-0687 |
Second Address | Lakewood, CO 80214-6125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2012 |
Last Update Date | 23/10/2012 |