Healthcare Provider Details

I. General information

NPI: 1285121871
Provider Name (Legal Business Name): ERICA EVERETT RMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/18/2018
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0018481
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: