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NPI Code Detail

MEDICARE: CORRINE COLORADO LMT

MEDICARE: CORRINE COLORADO LMT
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
1225700000XMassage Therapist56025CA

General Provider Information

NPI Number : 1639017890
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORRINE COLORADO LMT
Provider Business Mailing Address
First Line : 17040 RIDGE PARK DR
Second Line :
City : HACIENDA HEIGHTS
State : CA
Zip : 91745-3845
Country : US
Telephone Number : 626-324-6884
Fax Number :
Provider Business Practice Location Address
First Line : 17040 RIDGE PARK DR
Second Line :
City : HACIENDA HEIGHTS
State : CA
Zip : 91745-3845
Country : US
Telephone Number : 626-324-6884
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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