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General NPI Number Information
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NPI Number | 1780942441
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Entity Type | Individual
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Provider Name | BETTY ANN MASSINO MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 4112 OUTLOOK BLVD SUITE #96
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City | PUEBLO
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State | CO
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Zip | 81008-1667
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Country | US
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Telephone | 719-562-6200
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Fax | 719-562-6225
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Provider Business Mailing Address
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Address Line | 4112 OUTLOOK BLVD SUITE #96
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City | PUEBLO
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State | CO
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Zip | 81008-1667
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Country | US
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Telephone | 719-562-6200
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Fax | 719-562-6225
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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 | 5342
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License Number State | CO
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