Healthcare Provider Details

I. General information

NPI: 1730342916
Provider Name (Legal Business Name): REBECCA JANE COLBORNE L.M.T., M.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 CEDAR ST
ELKO NV
89801-3307
US

IV. Provider business mailing address

758 CEDAR ST
ELKO NV
89801-3307
US

V. Phone/Fax

Practice location:
  • Phone: 775-777-4797
  • Fax:
Mailing address:
  • Phone: 775-777-4797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2855
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: