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General NPI Number Information
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NPI Number | 1316895923
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Entity Type | Individual
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Provider Name | JASON R NEALLEY LMT, CLT
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Gender | Male
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Dates
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Enumeration Date | 03/19/2026
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Last Update Date | 03/19/2026
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Provider Practice Location Address
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Address Line | 680 MITCHELL WAY UNIT 160
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City | ERIE
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State | CO
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Zip | 80516-5457
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Country | US
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Telephone | 303-323-9931
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Fax |
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Provider Business Mailing Address
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Address Line | 3361 W TORREYS PEAK DR
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City | SUPERIOR
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State | CO
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Zip | 80027-4637
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Country | US
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Telephone |
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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.0014248
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License Number State | CO
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