Provider Demographics
NPI:1053867119
Name:LEFCOURT, MELISSA (RMT, AOS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LEFCOURT
Suffix:
Gender:F
Credentials:RMT, AOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 W 6TH AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1870
Mailing Address - Country:US
Mailing Address - Phone:720-432-4541
Mailing Address - Fax:
Practice Address - Street 1:2095 W 6TH AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1870
Practice Address - Country:US
Practice Address - Phone:720-432-4541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0004934225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist