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General NPI Number Information
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NPI Number | 1891338455
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Entity Type | Individual
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Provider Name | MITZI SCHIRADO LMT
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Gender | Female
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Dates
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Enumeration Date | 10/25/2019
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Last Update Date | 10/25/2019
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Provider Practice Location Address
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Address Line | 62543 US HWY 40 UNIT H
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City | GRANBY
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State | CO
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Zip | 80446-8044
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Country | US
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Telephone | 970-531-7414
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Fax |
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Provider Business Mailing Address
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Address Line | 440 COUNTY ROAD 4051
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City | GRANBY
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State | CO
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Zip | 80446-8716
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Country | US
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Telephone | 970-531-8020
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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.0018129
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License Number State | CO
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