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NPI Code Detail

MEDICARE: NICOL LEA SYVERTSON MASSAGE THERAPIST

MEDICARE: NICOL LEA SYVERTSON MASSAGE THERAPIST
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
1111NR0400XRehabilitation Chiropractor7684CO

General Provider Information

NPI Number : 1952607632
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOL LEA SYVERTSON MASSAGE THERAPIST
Provider Business Mailing Address
First Line : 3931 STONEGRASS PT
Second Line :
City : BROOMFIELD
State : CO
Zip : 80023-4022
Country : US
Telephone Number : 720-329-5687
Fax Number :
Provider Business Practice Location Address
First Line : 5140 W 120TH AVE UNIT 100
Second Line :
City : WESTMINSTER
State : CO
Zip : 80020-3336
Country : US
Telephone Number : 303-451-6706
Fax Number : 303-451-6706
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2011
Last Update Date : 01/28/2011

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