Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT.0022718 | CO |
NPI | 1003433277 |
---|---|
Provider Name | Matthew P Smith |
First Address | Denver, CO 80205-5588 |
Second Address | Denver, CO 80205-5588 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2020 |
Last Update Date | 02/07/2020 |