Provider Demographics
NPI:1104187087
Name:PATTEN, KARISSA LYNN-JOCQUE (RMT)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:LYNN-JOCQUE
Last Name:PATTEN
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6165 E ILIFF AVE
Mailing Address - Street 2:#C103
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5816
Mailing Address - Country:US
Mailing Address - Phone:406-852-3712
Mailing Address - Fax:
Practice Address - Street 1:8725 WADSWORTH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-0928
Practice Address - Country:US
Practice Address - Phone:303-425-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13015225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist