Healthcare Provider Details

I. General information

NPI: 1467363887
Provider Name (Legal Business Name): LARRY RAY ATENCIO LMT, NMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 CITADEL DR E STE 467
COLORADO SPRINGS CO
80909-5314
US

IV. Provider business mailing address

3939 E SAN MIGUEL ST
COLORADO SPRINGS CO
80909-3409
US

V. Phone/Fax

Practice location:
  • Phone: 719-505-9003
  • Fax: 719-505-9003
Mailing address:
  • Phone: 719-237-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0005848
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: