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General NPI Number Information
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NPI Number | 1881415164
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Entity Type | Individual
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Provider Name | KHOA DANG PHAM LMT
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Gender | Male
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 1650 38TH ST STE 100E
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City | BOULDER
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State | CO
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Zip | 80301-2624
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Country | US
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Telephone | 720-213-8001
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Fax |
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Provider Business Mailing Address
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Address Line | 6652 W HAMILTON DR
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City | LAKEWOOD
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State | CO
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Zip | 80227-5336
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Country | US
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Telephone | 512-903-8882
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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.0023938
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License Number State | CO
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