Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT.0015858 | CO |
NPI | 1003262122 |
---|---|
Provider Name | Sarah Klein |
First Address | Longmont, CO 80501-2049 |
Second Address | Longmont, CO 80501-5453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2016 |
Last Update Date | 07/05/2016 |