Healthcare Provider Details

I. General information

NPI: 1346456712
Provider Name (Legal Business Name): KRISTA MARCELLE REINHARDT-RUPRECHT MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA M REINHARDT MA

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N HARRISON AVE UNIT A
LAFAYETTE CO
80026-2310
US

IV. Provider business mailing address

104 N HARRISON AVE UNIT A
LAFAYETTE CO
80026-2310
US

V. Phone/Fax

Practice location:
  • Phone: 303-815-3984
  • Fax:
Mailing address:
  • Phone: 303-815-3984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberNLC.0105019
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: