Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 0021062 | CO |
NPI | 1003318866 |
---|---|
Provider Name | Shantel Beckers |
First Address | Golden, CO 80401-1746 |
Second Address | Westminster, CO 80020-4182 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2018 |
Last Update Date | 07/03/2018 |