=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851082143
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYLYNN LEINAALA JITCHAKU WAITE LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2023
-----------------------------------------------------
Last Update Date | 05/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12101 E 2ND AVE STE 100
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80011-8328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-588-8261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3848 S TRUCKEE WAY
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80013-3165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-557-0250
-----------------------------------------------------
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 | 0025420
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------