Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 4310 | CO |
NPI | 1003142928 |
---|---|
Provider Name | Sarah Jean Dubbe |
First Address | Longmont, CO 80503 |
Second Address | Longmont, CO 80503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2009 |
Last Update Date | 28/10/2009 |