Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 0008359 | CO |
NPI | 1003321571 |
---|---|
Provider Name | Mrs. Sarah Farley |
First Address | Broomfield, CO 80023-6567 |
Second Address | Boulder, CO 80305-5925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2017 |
Last Update Date | 06/12/2017 |