Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT-13285 | CO |
NPI | 1003177569 |
---|---|
Provider Name | Mr. Trent Erickson |
First Address | Commerce City, CO 80022-0543 |
Second Address | Northglenn, CO 80234-3095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 31/05/2012 |