Healthcare Provider Details

I. General information

NPI: 1134493562
Provider Name (Legal Business Name): RACHEL HEPPEL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 30TH ST STE 215
BOULDER CO
80301-1088
US

IV. Provider business mailing address

1800 30TH ST STE 215
BOULDER CO
80301-1026
US

V. Phone/Fax

Practice location:
  • Phone: 303-444-1171
  • Fax: 303-258-7425
Mailing address:
  • Phone: 303-444-1171
  • Fax: 303-258-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12351
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: