Healthcare Provider Details

I. General information

NPI: 1932469855
Provider Name (Legal Business Name): ROLLIE NICOLE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 W 115TH AVE UNIT 4
NORTHGLENN CO
80234-3095
US

IV. Provider business mailing address

455 W 115TH AVE UNIT 4
NORTHGLENN CO
80234-3095
US

V. Phone/Fax

Practice location:
  • Phone: 303-859-3263
  • Fax:
Mailing address:
  • Phone: 303-859-3263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-12788
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: