Provider Demographics
NPI:1073914537
Name:PADGETT, JACKIE (LMT)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:PADGETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5597 E MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1069
Mailing Address - Country:US
Mailing Address - Phone:303-758-4185
Mailing Address - Fax:
Practice Address - Street 1:2401 S DOWNING ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5811
Practice Address - Country:US
Practice Address - Phone:303-733-2727
Practice Address - Fax:303-733-2929
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9330225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist