Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | MT.0017978 | CO |
N | 2081S0010X | Sports Medicine | AT.0001355 | CO |
N | 213ES0000X | Sports Medicine | AT.0001355 | CO |
N | 225700000X | Massage Therapist | MT.0017978 | CO |
NPI | 1861930935 |
---|---|
Provider Name | Matti Bermingham |
First Address | Lakewood, CO 80228-6512 |
Second Address | Lakewood, CO 80228-1510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2017 |
Last Update Date | 09/11/2020 |