Healthcare Provider Details

I. General information

NPI: 1174821839
Provider Name (Legal Business Name): GINA MARIE ANDERSON RMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3938 JFK PKWY UNIT 11F
FORT COLLINS CO
80525-3087
US

IV. Provider business mailing address

PO BOX 271275
FORT COLLINS CO
80527-1275
US

V. Phone/Fax

Practice location:
  • Phone: 970-204-0516
  • Fax: 970-204-6812
Mailing address:
  • Phone: 970-204-0516
  • Fax: 970-204-6812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10306
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: