Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT.0017279 | CO |
NPI | 1003416579 |
---|---|
Provider Name | Ms. Sarah Wells |
First Address | Denver, CO 80220-2650 |
Second Address | Denver, CO 80220-2650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2020 |
Last Update Date | 26/10/2020 |