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General NPI Number Information
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NPI Number | 1467363887
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Entity Type | Individual
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Provider Name | LARRY RAY ATENCIO LMT, NMT
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Gender | Male
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Dates
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Enumeration Date | 09/15/2026
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Last Update Date | 09/15/2026
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Provider Practice Location Address
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Address Line | 685 CITADEL DR E STE 467
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5314
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Country | US
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Telephone | 719-505-9003
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Fax | 719-505-9003
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Provider Business Mailing Address
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Address Line | 3939 E SAN MIGUEL ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-3409
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Country | US
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Telephone | 719-237-5350
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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.0005848
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License Number State | CO
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