Healthcare Provider Details

I. General information

NPI: 1770463531
Provider Name (Legal Business Name): JAMES ALEXANDER BEDNAREK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 MOUNTAIN VIEW AVE STE 205
LONGMONT CO
80501-3177
US

IV. Provider business mailing address

2130 MOUNTAIN VIEW AVE STE 205
LONGMONT CO
80501-3177
US

V. Phone/Fax

Practice location:
  • Phone: 303-835-7882
  • Fax:
Mailing address:
  • Phone: 303-835-7882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0027225
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: