Healthcare Provider Details

I. General information

NPI: 1093441495
Provider Name (Legal Business Name): OLEG GORLACH LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6881 S HOLLY CIR
CENTENNIAL CO
80112-1145
US

IV. Provider business mailing address

17350 E LAKE DR
AURORA CO
80016-3209
US

V. Phone/Fax

Practice location:
  • Phone: 303-221-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: