Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2795 | CO |
NPI | 1003059775 |
---|---|
Provider Name | Mrs. Susan Mary Clingman |
First Address | Englewood, CO 80110-6364 |
Second Address | Englewood, CO 80110-6364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2009 |
Last Update Date | 21/01/2011 |