Healthcare Provider Details

I. General information

NPI: 1699405902
Provider Name (Legal Business Name): LAURA YETZER LMT, CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 S INDIAN CREEK ST
HIGHLANDS RANCH CO
80126-2101
US

IV. Provider business mailing address

8803 S INDIAN CREEK ST
HIGHLANDS RANCH CO
80126-2101
US

V. Phone/Fax

Practice location:
  • Phone: 720-205-7055
  • Fax:
Mailing address:
  • Phone: 720-205-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0024879
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: