Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2190 | CO |
NPI | 1013248970 |
---|---|
Provider Name | Stephen Korsmo |
First Address | Parker, CO 80134-4951 |
Second Address | Parker, CO 80134-4951 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2010 |
Last Update Date | 16/02/2010 |