Provider Demographics
NPI:1083101562
Name:POLIDORE, FELICIA (LMT, CMT)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:POLIDORE
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4974 FUNDY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-7507
Mailing Address - Country:US
Mailing Address - Phone:720-276-3341
Mailing Address - Fax:
Practice Address - Street 1:4974 FUNDY ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-7507
Practice Address - Country:US
Practice Address - Phone:720-276-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0009733225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist