Healthcare Provider Details

I. General information

NPI: 1770101412
Provider Name (Legal Business Name): ELIZABETH EDELMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 E EXPOSITION AVE STE 320
DENVER CO
80209-5033
US

IV. Provider business mailing address

4525 E KENTUCKY CIR
DENVER CO
80246-2001
US

V. Phone/Fax

Practice location:
  • Phone: 303-777-1151
  • Fax:
Mailing address:
  • Phone: 206-940-5504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT00023493
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: