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NPI Code Detail

MEDICARE: COURTNEY LEIGH BORRADAILE LMT

MEDICARE: COURTNEY LEIGH BORRADAILE LMT
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
1225700000XMassage TherapistMT0018877CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MT0018877OTHERCOLICENSE

General Provider Information

NPI Number : 1992295786
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY LEIGH BORRADAILE LMT
Provider Business Mailing Address
First Line : 1802 CHAPEL HILLS DR STE E
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-3736
Country : US
Telephone Number : 719-531-7188
Fax Number : 719-531-0880
Provider Business Practice Location Address
First Line : 2620 TENDERFOOT HILL ST STE 10
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-8354
Country : US
Telephone Number : 719-527-6747
Fax Number : 719-579-9623
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2018
Last Update Date : 05/16/2018

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Directions to “ COURTNEY LEIGH BORRADAILE LMT” Practice Location

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