Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 0023613 | CO |
NPI | 1013521319 |
---|---|
Provider Name | Kyle Dokken |
First Address | Loveland, CO 80538-1591 |
Second Address | Loveland, CO 80538-1591 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2020 |
Last Update Date | 03/09/2020 |