Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 7786 | CO |
NPI | 1023190121 |
---|---|
Provider Name | Mrs. Mara Lynn Lund |
First Address | Broomfield, CO 80020-1730 |
Second Address | Broomfield, CO 80020-1730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 10/01/2008 |