Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT.0001692 | CO |
NPI | 1003457516 |
---|---|
Provider Name | Teresa Ann Brown |
First Address | Littleton, CO 80120-4116 |
Second Address | Englewood, CO 80113-2674 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2019 |
Last Update Date | 06/10/2019 |