Healthcare Provider Details

I. General information

NPI: 1699637165
Provider Name (Legal Business Name): DIAMOND NICOLE HORNER MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27925 BAMBI AVE
SIMLA CO
80835-8900
US

IV. Provider business mailing address

27925 BAMBI AVE
SIMLA CO
80835-8900
US

V. Phone/Fax

Practice location:
  • Phone: 720-955-4055
  • Fax:
Mailing address:
  • Phone: 720-955-4055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0018616
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: