Provider Demographics
NPI:1003670381
Name:LOUSTAUNAU, MANON
Entity Type:Individual
Prefix:
First Name:MANON
Middle Name:
Last Name:LOUSTAUNAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 W 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2524
Mailing Address - Country:US
Mailing Address - Phone:804-399-7620
Mailing Address - Fax:
Practice Address - Street 1:1260 E 1ST AVE UNIT A
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-3792
Practice Address - Country:US
Practice Address - Phone:720-716-4518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0026175225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist