Provider Demographics
NPI:1093058281
Name:BANAGA, NADEZHDA (LMT)
Entity Type:Individual
Prefix:
First Name:NADEZHDA
Middle Name:
Last Name:BANAGA
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 1:11727 FENTON ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5970
Mailing Address - Country:US
Mailing Address - Phone:720-341-7998
Mailing Address - Fax:
Practice Address - Street 1:12001 TEJON ST
Practice Address - Street 2:#122
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2310
Practice Address - Country:US
Practice Address - Phone:303-464-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0008422172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist