Healthcare Provider Details

I. General information

NPI: 1457618340
Provider Name (Legal Business Name): AMY J ROSE RN, LMT, CNMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 N GREENWOOD ST
PUEBLO CO
81003-2927
US

IV. Provider business mailing address

955 N GREENWOOD ST
PUEBLO CO
81003-2927
US

V. Phone/Fax

Practice location:
  • Phone: 719-256-0797
  • Fax:
Mailing address:
  • Phone: 719-256-0797
  • Fax: 719-285-0781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-8840
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberRN.1623859
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: