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General NPI Number Information
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NPI Number | 1619538402
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Entity Type | Individual
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Provider Name | ALYSSA MITHCELL
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Gender | Female
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 2030 35TH AVE STE B
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City | GREELEY
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State | CO
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Zip | 80634-3944
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Country | US
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Telephone | 370-330-3554
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Fax |
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Provider Business Mailing Address
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Address Line | 232 42ND AVE
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City | GREELEY
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State | CO
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Zip | 80634-1104
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Country | US
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Telephone | 970-301-9290
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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 | MT0021786
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License Number State | CO
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