MEDICARE: ALEXANDER DENNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT.0017583	CO

General Provider Information

NPI Number	:	1609696988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER DENNER

Provider Business Mailing Address
First Line	:	221 E 4TH AVE UNIT 2
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-5783
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1032 1/2 MAIN AVE STE 28
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-5124
Country	:	US
Telephone Number	:	970-749-0936
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2024
Last Update Date	:	10/11/2024

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Directions to “ ALEXANDER DENNER ” Practice Location

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