Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT-431 | CO |
NPI | 1013206150 |
---|---|
Provider Name | Kimberly Coyle Meyer-Straw |
First Address | Fort Collins, CO 80524-3926 |
Second Address | Fort Collins, CO 80524-3926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2011 |
Last Update Date | 29/03/2011 |