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General NPI Number Information
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NPI Number | 1497078331
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Entity Type | Individual
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Provider Name | MARY H BASHKIN C.M.T.
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Gender | Female
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Dates
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Enumeration Date | 03/06/2010
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Last Update Date | 03/09/2010
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Provider Practice Location Address
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Address Line | 315 CANYON AVE SUITE A
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City | FORT COLLINS
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State | CO
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Zip | 80521-2677
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Country | US
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Telephone | 970-391-7491
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2261
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City | FORT COLLINS
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State | CO
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Zip | 80522-2261
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Country | US
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Telephone | 970-391-7491
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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 | 909
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License Number State | CO
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