Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT.0017680 | CO |
NPI | 1003446014 |
---|---|
Provider Name | Trey Barnes |
First Address | Aspen, CO 81611-1828 |
Second Address | Aspen, CO 81611-1828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2020 |
Last Update Date | 17/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MT.0017680 | DORA (01) | CO |