Healthcare Provider Details

I. General information

NPI: 1417530064
Provider Name (Legal Business Name): DANIELLE RUZYCKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2021
Last Update Date: 05/02/2021
Certification Date: 05/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2358 S UNIVERSITY BLVD APT 4
DENVER CO
80210-5436
US

IV. Provider business mailing address

2358 S UNIVERSITY BLVD APT 4
DENVER CO
80210-5436
US

V. Phone/Fax

Practice location:
  • Phone: 303-547-0497
  • Fax:
Mailing address:
  • Phone: 303-547-0497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0023254
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: