Healthcare Provider Details

I. General information

NPI: 1811819659
Provider Name (Legal Business Name): KARIN H LINNER PETLOCK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 ARBOR DR
LAFAYETTE CO
80026-1729
US

IV. Provider business mailing address

518 ARBOR DR
LAFAYETTE CO
80026-1729
US

V. Phone/Fax

Practice location:
  • Phone: 917-403-7233
  • Fax:
Mailing address:
  • Phone: 917-403-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0010164
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: