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General NPI Number Information
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NPI Number | 1225634330
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Entity Type | Individual
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Provider Name | MANDY J MUSSO-MCLEMORE LMT
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Gender | Female
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Dates
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Enumeration Date | 12/05/2020
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Last Update Date | 12/05/2020
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Provider Practice Location Address
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Address Line | 2305 E ARAPAHOE RD STE 216
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City | CENTENNIAL
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State | CO
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Zip | 80122-1538
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Country | US
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Telephone | 720-646-2345
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Fax |
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Provider Business Mailing Address
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Address Line | 3556 N MONROE ST
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City | DENVER
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State | CO
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Zip | 80205-4364
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Country | US
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Telephone | 720-646-2345
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT.0020113
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License Number State | CO
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