Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT.0018844 | CO |
NPI | 1003317397 |
---|---|
Provider Name | Jorge Isaac Martinez Huerta |
First Address | Colorado Springs, CO 80909-2117 |
Second Address | Colorado Springs, CO 80919-1933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2018 |
Last Update Date | 17/03/2018 |