MEDICARE: JULIE RAE STOLTMAN CMT, CPT, RYT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	225700000X	Massage Therapist	MT.0024182	CO

General Provider Information

NPI Number	:	1073915138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE RAE STOLTMAN CMT, CPT, RYT

Provider Business Mailing Address
First Line	:	5736 STONE FLY DR
Second Line	:
City	:	TIMNATH
State	:	CO
Zip	:	80547-5841
Country	:	US
Telephone Number	:	612-203-1749
Fax Number	:

Provider Business Practice Location Address
First Line	:	904 AKIN AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2527
Country	:	US
Telephone Number	:	612-203-1749
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	10/19/2021

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