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General NPI Number Information
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NPI Number | 1689185191
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Entity Type | Individual
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Provider Name | ERICA LEANNE KAISER LMT
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Gender | Female
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Dates
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Enumeration Date | 10/24/2017
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Last Update Date | 10/24/2017
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Provider Practice Location Address
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Address Line | 117 W 6TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-3119
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Country | US
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Telephone | 719-543-6400
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Fax | 719-543-1464
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Provider Business Mailing Address
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Address Line | 157 E BIRCH HILLS DR
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City | PUEBLO
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State | CO
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Zip | 81007-7507
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Country | US
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Telephone | 720-388-4764
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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.0006161
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License Number State | CO
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