Healthcare Provider Details

I. General information

NPI: 1699783704
Provider Name (Legal Business Name): SHERRY J LITASI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 KINGSTON MAIN ST
KINGSTON NM
88042
US

IV. Provider business mailing address

48 KINGSTON MAIN ST
HILLSBORO NM
88042-9514
US

V. Phone/Fax

Practice location:
  • Phone: 303-324-2305
  • Fax:
Mailing address:
  • Phone: 303-324-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT7423
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT596
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: