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General NPI Number Information
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NPI Number | 1326747114
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Entity Type | Individual
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Provider Name | JUSTIN PAUL DONNAN LMT
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Gender | Male
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Dates
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Enumeration Date | 03/01/2023
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 11990 GRANT ST STE 400
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City | NORTHGLENN
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State | CO
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Zip | 80233-1136
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Country | US
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Telephone | 720-773-2464
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Fax |
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Provider Business Mailing Address
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Address Line | 10305 DOVER ST APT 10-1039
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City | WESTMINSTER
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State | CO
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Zip | 80021-3970
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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.0021891
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License Number State | CO
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