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General NPI Number Information
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NPI Number | 1649940149
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Entity Type | Individual
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Provider Name | DIANA ROMICK LMT, CMLDT
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Gender | Female
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 809 30TH AVE UNIT 3
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City | GREELEY
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State | CO
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Zip | 80634-5118
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Country | US
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Telephone | 970-400-7235
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Fax |
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Provider Business Mailing Address
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Address Line | 732 HARP CT
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City | GREELEY
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State | CO
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Zip | 80634-5821
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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.0020595
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License Number State | CO
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