Healthcare Provider Details

I. General information

NPI: 1174469043
Provider Name (Legal Business Name): REBECCA CLOSE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 COWLES AVE APT C407
LONGMONT CO
80504-8630
US

IV. Provider business mailing address

1685 COWLES AVE APT C407
LONGMONT CO
80504-8630
US

V. Phone/Fax

Practice location:
  • Phone: 443-285-1799
  • Fax:
Mailing address:
  • Phone: 443-285-1799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0031046
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: