Healthcare Provider Details

I. General information

NPI: 1376477018
Provider Name (Legal Business Name): JONATHAN JOEL SERRANO ROMAN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6820 PARKRIDGE CT
COLORADO SPRINGS CO
80915-3159
US

IV. Provider business mailing address

6820 PARKRIDGE CT
COLORADO SPRINGS CO
80915-3159
US

V. Phone/Fax

Practice location:
  • Phone: 719-232-1245
  • Fax:
Mailing address:
  • Phone: 719-232-1245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0023895
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: