=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699783704
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERRY J LITASI LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2006
-----------------------------------------------------
Last Update Date | 03/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 48 KINGSTON MAIN ST
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-324-2305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 48 KINGSTON MAIN ST
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88042-9514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-324-2305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT7423
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT596
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------