Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 13314 | CO |
NPI | 1013251354 |
---|---|
Provider Name | Nikita Gonzales |
First Address | Colorado Springs, CO 80905-6350 |
Second Address | Colorado Springs, CO 80922-3204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2012 |
Last Update Date | 26/11/2012 |