Healthcare Provider Details

I. General information

NPI: 1871009340
Provider Name (Legal Business Name): JENNIFER VIGIL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 W 120TH AVE STE B
WESTMINSTER CO
80234-2446
US

IV. Provider business mailing address

PO BOX 352076
WESTMINSTER CO
80035-2076
US

V. Phone/Fax

Practice location:
  • Phone: 303-920-2350
  • Fax: 303-253-1085
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number20135
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: