Healthcare Provider Details

I. General information

NPI: 1730427121
Provider Name (Legal Business Name): NATHAN CUDDIHY-GARNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2013
Last Update Date: 01/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 NICKEL ST SUITE 200
BROOMFIELD CO
80020-2183
US

IV. Provider business mailing address

4252 BROEMEL AVE
BROOMFIELD CO
80020-7926
US

V. Phone/Fax

Practice location:
  • Phone: 303-460-9151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2555
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: