Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 3580 | CO |
N | 225700000X | Massage Therapist |
NPI | 1073757035 |
---|---|
Provider Name | Mark Plaatjes |
First Address | Boulder, CO 80302-3811 |
Second Address | Boulder, CO 80302-3811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2009 |
Last Update Date | 21/04/2009 |