Healthcare Provider Details

I. General information

NPI: 1033584834
Provider Name (Legal Business Name): LAURA ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 TABLE MESA DR SUITE B
BOULDER CO
80305-4503
US

IV. Provider business mailing address

4710 TABLE MESA DRIVE SUITE B
BOULDER CO
80305
US

V. Phone/Fax

Practice location:
  • Phone: 303-499-9892
  • Fax:
Mailing address:
  • Phone: 303-499-9892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0017141
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: