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General NPI Number Information
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NPI Number | 1245668474
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Entity Type | Organization
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Legal Business Name | BOULDER THERAPEUTICS, INC.
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Dates
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Enumeration Date | 10/25/2013
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Last Update Date | 10/28/2013
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Provider Practice Location Address
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Address Line | 1800 30TH ST STE 215
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City | BOULDER
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State | CO
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Zip | 80301-1026
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Country | US
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Telephone | 303-444-1171
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Fax |
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Provider Business Mailing Address
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Address Line | 1053 W CENTURY DR APT 107
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City | LOUISVILLE
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State | CO
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Zip | 80027-1608
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Country | US
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Telephone | 303-960-8616
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | MYRIAM DESROSIERS SCHMATZ
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Credential | CMT, RMT
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Telephone | 303-960-8616
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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 | M.T.0014772
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License Number State | CO
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