MEDICARE: MASON D DOUILLARD LMT, CERT. ROLFER

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	0027673	CO

General Provider Information

NPI Number	:	1871451906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASON D DOUILLARD LMT, CERT. ROLFER

Provider Business Mailing Address
First Line	:	8235 N 81ST ST
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80503-8750
Country	:	US
Telephone Number	:	303-807-6165
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 ALPINE AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-3413
Country	:	US
Telephone Number	:	303-807-6165
Fax Number	:

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

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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