Healthcare Provider Details

I. General information

NPI: 1831477009
Provider Name (Legal Business Name): GUY LYNN SCARBOROUGH JR. MASSAGE THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 VIA LINDA VIS
MANITOU SPRINGS CO
80829-2460
US

IV. Provider business mailing address

220 VIA LINDA VIS
MANITOU SPRINGS CO
80829-2460
US

V. Phone/Fax

Practice location:
  • Phone: 719-685-9587
  • Fax:
Mailing address:
  • Phone: 719-685-9587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11789
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: