Provider Demographics
NPI:1053633958
Name:MAULDIN, REBECCA (RMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MAULDIN
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5114
Mailing Address - Country:US
Mailing Address - Phone:970-385-5142
Mailing Address - Fax:970-247-2080
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:STE 150
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7306
Practice Address - Country:US
Practice Address - Phone:970-375-2273
Practice Address - Fax:970-375-2207
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO992225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist