Healthcare Provider Details

I. General information

NPI: 1174932206
Provider Name (Legal Business Name): JESSICA KRAUS LMT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2014
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E SWALLOW RD
FORT COLLINS CO
80525-2539
US

IV. Provider business mailing address

2702 LEISURE DR
FORT COLLINS CO
80525-2110
US

V. Phone/Fax

Practice location:
  • Phone: 970-223-7425
  • Fax: 866-225-2126
Mailing address:
  • Phone: 970-388-3781
  • Fax: 866-225-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number0009325
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA KRAUS
Title or Position: MASSAGE THERAPIST
Credential: LMT
Phone: 970-388-3781