Healthcare Provider Details

I. General information

NPI: 1881011229
Provider Name (Legal Business Name): CAITLIN DYGULSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 TABLE MESA DR SUITE 203
BOULDER CO
80305-5869
US

IV. Provider business mailing address

3400 TABLE MESA DR SUITE 203
BOULDER CO
80305-5869
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 Number12594
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: