Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT.0012515 | CO |
NPI | 1003206764 |
---|---|
Provider Name | Kristen Tobiassen |
First Address | Gunnison, CO 81230-2219 |
Second Address | Gunnison, CO 81230-2219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2015 |
Last Update Date | 22/08/2016 |