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General NPI Number Information
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NPI Number | 1790949436
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Entity Type | Individual
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Provider Name | COLLEEN MARGARET LAINE CMT CNMT MAT SPECIAL
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Gender | Female
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Dates
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Enumeration Date | 07/11/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 3501 S CORONA ST SUITE #1
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City | ENGLEWOOD
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State | CO
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Zip | 80113-3907
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Country | US
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Telephone | 303-320-4367
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Fax | 303-762-8822
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Provider Business Mailing Address
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Address Line | 2700 JULIAN ST
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City | DENVER
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State | CO
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Zip | 80211-4025
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Country | US
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Telephone | 303-477-3025
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Fax | 303-762-8822
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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 |
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License Number State |
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